Provider Demographics
NPI:1073385357
Name:SMARJESSE, CARA ROSELLA (WHNP-BC)
Entity Type:Individual
Prefix:
First Name:CARA
Middle Name:ROSELLA
Last Name:SMARJESSE
Suffix:
Gender:F
Credentials:WHNP-BC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:11011 W NORTH AVE APT 422
Mailing Address - Street 2:
Mailing Address - City:WAUWATOSA
Mailing Address - State:WI
Mailing Address - Zip Code:53226-2273
Mailing Address - Country:US
Mailing Address - Phone:309-635-3472
Mailing Address - Fax:
Practice Address - Street 1:787 N BROADWAY
Practice Address - Street 2:
Practice Address - City:MILWAUKEE
Practice Address - State:WI
Practice Address - Zip Code:53202-3614
Practice Address - Country:US
Practice Address - Phone:262-518-7448
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2023-10-30
Last Update Date:2023-10-30
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IL041463253363LW0102X
WI1102204363LW0102X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LW0102XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerWomen's Health