Provider Demographics
NPI:1013289164
Name:TSOGBE, MAUREEN (FNP-BC)
Entity type:Individual
Prefix:
First Name:MAUREEN
Middle Name:
Last Name:TSOGBE
Suffix:
Gender:F
Credentials:FNP-BC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:5300 W VILLARD AVE
Mailing Address - Street 2:
Mailing Address - City:MILWAUKEE
Mailing Address - State:WI
Mailing Address - Zip Code:53218-4345
Mailing Address - Country:US
Mailing Address - Phone:414-438-6666
Mailing Address - Fax:414-438-6667
Practice Address - Street 1:5300 W VILLARD AVE
Practice Address - Street 2:
Practice Address - City:MILWAUKEE
Practice Address - State:WI
Practice Address - Zip Code:53218-4345
Practice Address - Country:US
Practice Address - Phone:414-438-6666
Practice Address - Fax:414-438-6667
Is Sole Proprietor?:No
Enumeration Date:2012-02-06
Last Update Date:2012-05-07
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WI4763-33363LF0000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LF0000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerFamily