Provider Demographics
NPI:1457822058
Name:CONCEPCION, JOHN (FNP-BC)
Entity Type:Individual
Prefix:
First Name:JOHN
Middle Name:
Last Name:CONCEPCION
Suffix:
Gender:M
Credentials:FNP-BC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:10200 W INNOVATION DR STE 400
Mailing Address - Street 2:
Mailing Address - City:MILWAUKEE
Mailing Address - State:WI
Mailing Address - Zip Code:53226-4826
Mailing Address - Country:US
Mailing Address - Phone:414-944-2000
Mailing Address - Fax:414-944-2092
Practice Address - Street 1:10200 W INNOVATION DR STE 400
Practice Address - Street 2:
Practice Address - City:MILWAUKEE
Practice Address - State:WI
Practice Address - Zip Code:53226-4826
Practice Address - Country:US
Practice Address - Phone:414-944-2000
Practice Address - Fax:414-944-2092
Is Sole Proprietor?:No
Enumeration Date:2018-12-08
Last Update Date:2021-05-12
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WI8908363LF0000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LF0000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerFamily