Provider Demographics
NPI:1114971488
Name:MILLER NIKLASCH, DENISE A (APNP)
Entity Type:Individual
Prefix:MS
First Name:DENISE
Middle Name:A
Last Name:MILLER NIKLASCH
Suffix:
Gender:F
Credentials:APNP
Other - Prefix:MS
Other - First Name:DENISE
Other - Middle Name:M
Other - Last Name:LEMKE
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:APNP
Mailing Address - Street 1:9200 W WISCONSIN AVE
Mailing Address - Street 2:DEPARTMENT OF NEUROLOGY
Mailing Address - City:MILWAUKEE
Mailing Address - State:WI
Mailing Address - Zip Code:53226-3522
Mailing Address - Country:US
Mailing Address - Phone:414-805-3122
Mailing Address - Fax:414-259-9290
Practice Address - Street 1:9200 W WISCONSIN AVE
Practice Address - Street 2:DEPARTMENT OF NEUROLOGY
Practice Address - City:MILWAUKEE
Practice Address - State:WI
Practice Address - Zip Code:53226-3522
Practice Address - Country:US
Practice Address - Phone:414-805-3122
Practice Address - Fax:414-259-9290
Is Sole Proprietor?:No
Enumeration Date:2006-05-20
Last Update Date:2013-12-11
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WI1659033363L00000X
WI1659363LA2200X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LA2200XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerAdult Health
No363L00000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse Practitioner
Provider Identifiers
StateIdentifier IDID TypeIssuer
WI1114971488Medicaid
WI1114971488Medicaid
WI068L 73-601Medicare PIN