Provider Demographics
NPI:1760099162
Name:ROHACH, ANDREA JUNE (RN, CPNP-AC, APNP)
Entity Type:Individual
Prefix:MRS
First Name:ANDREA
Middle Name:JUNE
Last Name:ROHACH
Suffix:
Gender:F
Credentials:RN, CPNP-AC, APNP
Other - Prefix:MRS
Other - First Name:ANDREA
Other - Middle Name:JUNE
Other - Last Name:HORNAK
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:BSN, RN
Mailing Address - Street 1:3240 E RYAN RD
Mailing Address - Street 2:
Mailing Address - City:OAK CREEK
Mailing Address - State:WI
Mailing Address - Zip Code:53154-4740
Mailing Address - Country:US
Mailing Address - Phone:414-690-6010
Mailing Address - Fax:
Practice Address - Street 1:9000 W WISCONSIN AVE
Practice Address - Street 2:
Practice Address - City:MILWAUKEE
Practice Address - State:WI
Practice Address - Zip Code:53226-4874
Practice Address - Country:US
Practice Address - Phone:414-266-3560
Practice Address - Fax:414-266-6092
Is Sole Proprietor?:No
Enumeration Date:2020-09-29
Last Update Date:2020-12-03
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WI200488-30163WP0200X
WI10543-33363LP0200X, 363LA2100X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LA2100XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerAcute Care
No163WP0200XNursing Service ProvidersRegistered NursePediatrics
No363LP0200XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerPediatrics