Provider Demographics
NPI:1518597863
Name:ANDRESEN, JAMES JOSEPH
Entity Type:Individual
Prefix:
First Name:JAMES
Middle Name:JOSEPH
Last Name:ANDRESEN
Suffix:
Gender:M
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:5434 CHARLES ST
Mailing Address - Street 2:
Mailing Address - City:RACINE
Mailing Address - State:WI
Mailing Address - Zip Code:53402-2122
Mailing Address - Country:US
Mailing Address - Phone:414-731-7769
Mailing Address - Fax:
Practice Address - Street 1:3409 N DOWNER AVE
Practice Address - Street 2:
Practice Address - City:MILWAUKEE
Practice Address - State:WI
Practice Address - Zip Code:53211-2934
Practice Address - Country:US
Practice Address - Phone:414-731-7769
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2020-01-24
Last Update Date:2020-01-24
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes390200000XStudent, Health CareStudent in an Organized Health Care Education/Training Program