Provider Demographics
NPI:1932464468
Name:VICTOR, ANNALYSE VICTORIA (MSN, APNP)
Entity Type:Individual
Prefix:
First Name:ANNALYSE
Middle Name:VICTORIA
Last Name:VICTOR
Suffix:
Gender:F
Credentials:MSN, APNP
Other - Prefix:
Other - First Name:ANNALYSE
Other - Middle Name:VICTORIA
Other - Last Name:KREGER
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:
Mailing Address - Street 1:W369S10410 SHEARER RD
Mailing Address - Street 2:
Mailing Address - City:EAGLE
Mailing Address - State:WI
Mailing Address - Zip Code:53119-1719
Mailing Address - Country:US
Mailing Address - Phone:262-930-0005
Mailing Address - Fax:
Practice Address - Street 1:N16W24131 RIVERWOOD DR
Practice Address - Street 2:CANCER CENTER
Practice Address - City:WAUKESHA
Practice Address - State:WI
Practice Address - Zip Code:53188-1106
Practice Address - Country:US
Practice Address - Phone:262-930-0005
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2012-07-11
Last Update Date:2018-12-28
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WI17809930163WX0200X
WI6452363LF0000X
WI6452-33363LP2300X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LP2300XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerPrimary Care
No163WX0200XNursing Service ProvidersRegistered NurseOncology
No363LF0000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerFamily