Provider Demographics
NPI:1275570905
Name:PEARSON, TWILA M (APNP, PHD)
Entity Type:Individual
Prefix:MS
First Name:TWILA
Middle Name:M
Last Name:PEARSON
Suffix:
Gender:F
Credentials:APNP, PHD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:34700 VALLEY RD
Mailing Address - Street 2:
Mailing Address - City:OCONOMOWOC
Mailing Address - State:WI
Mailing Address - Zip Code:53066-4500
Mailing Address - Country:US
Mailing Address - Phone:262-646-4411
Mailing Address - Fax:262-646-1049
Practice Address - Street 1:5000 W CHAMBERS ST
Practice Address - Street 2:POB - ROOM 210
Practice Address - City:MILWAUKEE
Practice Address - State:WI
Practice Address - Zip Code:53210-1650
Practice Address - Country:US
Practice Address - Phone:414-874-1171
Practice Address - Fax:414-874-1177
Is Sole Proprietor?:No
Enumeration Date:2006-06-01
Last Update Date:2021-12-10
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WI1687363L00000X
WI1687-33364SP0807X, 364SP0809X
WI1687033363LP0808X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LP0808XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerPsychiatric/Mental Health
No363L00000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse Practitioner
No364SP0807XPhysician Assistants & Advanced Practice Nursing ProvidersClinical Nurse SpecialistPsychiatric/Mental Health, Child & Adolescent
No364SP0809XPhysician Assistants & Advanced Practice Nursing ProvidersClinical Nurse SpecialistPsychiatric/Mental Health, Adult
Provider Identifiers
StateIdentifier IDID TypeIssuer
WI39127500Medicaid
WI43600100Medicaid
WI0012-00106Medicare ID - Type UnspecifiedMEDICARE SEQUENCE NUMBER
WI43600100Medicaid
WIP13029Medicare UPIN
WI0035-00109Medicare ID - Type UnspecifiedMEDICARE SEQUENCE NUMBER