Provider Demographics
NPI:1801184288
Name:KNEZEVICH, MARGARET ANN (NP)
Entity Type:Individual
Prefix:MS
First Name:MARGARET
Middle Name:ANN
Last Name:KNEZEVICH
Suffix:
Gender:F
Credentials:NP
Other - Prefix:
Other - First Name:MARGARET
Other - Middle Name:
Other - Last Name:KOVAL
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:
Mailing Address - Street 1:14420 SUNRISE AVE
Mailing Address - Street 2:
Mailing Address - City:BROOKFIELD
Mailing Address - State:WI
Mailing Address - Zip Code:53005-1144
Mailing Address - Country:US
Mailing Address - Phone:414-659-2531
Mailing Address - Fax:
Practice Address - Street 1:W180N8000 TOWN HALL RD
Practice Address - Street 2:
Practice Address - City:MENOMONEE FALLS
Practice Address - State:WI
Practice Address - Zip Code:53051-4002
Practice Address - Country:US
Practice Address - Phone:262-255-2500
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2011-07-19
Last Update Date:2024-02-06
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WI9413-33363L00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363L00000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse Practitioner
Provider Identifiers
StateIdentifier IDID TypeIssuer
WI1801184288Medicaid