Provider Demographics
NPI:1053669846
Name:SZULA, NICHOLE (PA-C)
Entity Type:Individual
Prefix:MRS
First Name:NICHOLE
Middle Name:
Last Name:SZULA
Suffix:
Gender:F
Credentials:PA-C
Other - Prefix:MISS
Other - First Name:NICHOLE
Other - Middle Name:
Other - Last Name:STEFFEN
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:PA-C
Mailing Address - Street 1:9000 W WISCONSIN AVE
Mailing Address - Street 2:
Mailing Address - City:MILWAUKEE
Mailing Address - State:WI
Mailing Address - Zip Code:53226-4874
Mailing Address - Country:US
Mailing Address - Phone:414-955-6450
Mailing Address - Fax:414-955-0082
Practice Address - Street 1:9200 W WISCONSIN AVE
Practice Address - Street 2:
Practice Address - City:MILWAUKEE
Practice Address - State:WI
Practice Address - Zip Code:53226-3522
Practice Address - Country:US
Practice Address - Phone:414-805-6450
Practice Address - Fax:414-805-6464
Is Sole Proprietor?:No
Enumeration Date:2012-08-27
Last Update Date:2022-11-16
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TXPA07950363A00000X
WI4610363A00000X
IL085007047363A00000X
CAPA51731363A00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363A00000XPhysician Assistants & Advanced Practice Nursing ProvidersPhysician Assistant
Provider Identifiers
StateIdentifier IDID TypeIssuer
WI1053669846Medicaid
WI100085654Medicaid