Provider Demographics
NPI:1437630761
Name:GHANEM, EMILY MARIE (NP)
Entity Type:Individual
Prefix:
First Name:EMILY
Middle Name:MARIE
Last Name:GHANEM
Suffix:
Gender:F
Credentials:NP
Other - Prefix:
Other - First Name:EMILY
Other - Middle Name:MARIE
Other - Last Name:HUNN
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:MAIDEN NAME
Mailing Address - Street 1:N17W30708 WOODLAND HILL DR
Mailing Address - Street 2:
Mailing Address - City:DELAFIELD
Mailing Address - State:WI
Mailing Address - Zip Code:53018-2162
Mailing Address - Country:US
Mailing Address - Phone:262-442-4435
Mailing Address - Fax:
Practice Address - Street 1:17000 W NORTH AVE STE 200E
Practice Address - Street 2:
Practice Address - City:BROOKFIELD
Practice Address - State:WI
Practice Address - Zip Code:53005-4425
Practice Address - Country:US
Practice Address - Phone:262-782-4270
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2018-08-24
Last Update Date:2024-04-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WI8328363L00000X
WI8328-33363LF0000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LF0000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerFamily
No363L00000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse Practitioner
Provider Identifiers
StateIdentifier IDID TypeIssuer
WI8328-33OtherADVANCED PRACTICE NURSE PRESCRIBER (APNP) LICENSE NUMBER
WI100081427Medicaid