Provider Demographics
NPI:1891065967
Name:DRAGHICCHIO, ANN M (NP)
Entity Type:Individual
Prefix:
First Name:ANN
Middle Name:M
Last Name:DRAGHICCHIO
Suffix:
Gender:F
Credentials:NP
Other - Prefix:
Other - First Name:ANN
Other - Middle Name:M
Other - Last Name:WILFORD
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:
Mailing Address - Street 1:959 N MAYFAIR ROAD
Mailing Address - Street 2:
Mailing Address - City:MILWAUKEE
Mailing Address - State:WI
Mailing Address - Zip Code:53226
Mailing Address - Country:US
Mailing Address - Phone:414-955-7601
Mailing Address - Fax:414-955-6020
Practice Address - Street 1:W180N8085 TOWN HALL RD
Practice Address - Street 2:
Practice Address - City:MENOMONEE FALLS
Practice Address - State:WI
Practice Address - Zip Code:53051-3518
Practice Address - Country:US
Practice Address - Phone:262-257-2784
Practice Address - Fax:262-250-7440
Is Sole Proprietor?:No
Enumeration Date:2012-01-06
Last Update Date:2020-05-21
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WI121465363LF0000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LF0000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerFamily
Provider Identifiers
StateIdentifier IDID TypeIssuer
WI1891065967Medicaid
WI73601 2370Medicare PIN
WI68086 1165Medicare PIN