Provider Demographics
NPI:1801842125
Name:NASIF, SUSAN LR (APNP)
Entity Type:Individual
Prefix:
First Name:SUSAN
Middle Name:LR
Last Name:NASIF
Suffix:
Gender:F
Credentials:APNP
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:2025 E NEWPORT AVE
Mailing Address - Street 2:
Mailing Address - City:MILWAUKEE
Mailing Address - State:WI
Mailing Address - Zip Code:53211-2906
Mailing Address - Country:US
Mailing Address - Phone:414-906-3560
Mailing Address - Fax:
Practice Address - Street 1:1055 N MAYFAIR RD
Practice Address - Street 2:
Practice Address - City:WAUWATOSA
Practice Address - State:WI
Practice Address - Zip Code:53226-3436
Practice Address - Country:US
Practice Address - Phone:414-479-8695
Practice Address - Fax:414-476-8440
Is Sole Proprietor?:No
Enumeration Date:2006-05-26
Last Update Date:2008-12-16
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WI2790363LA2200X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LA2200XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerAdult Health