Provider Demographics
NPI:1023297264
Name:AUSSEM, KATHERINE E (PNP)
Entity type:Individual
Prefix:MS
First Name:KATHERINE
Middle Name:E
Last Name:AUSSEM
Suffix:
Gender:F
Credentials:PNP
Other - Prefix:MS
Other - First Name:KATHERINE
Other - Middle Name:E AUSSEM
Other - Last Name:KRESSIN
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:PNP
Mailing Address - Street 1:9000 W WISCONSIN AVE
Mailing Address - Street 2:PEDIATRIC UROLOGY
Mailing Address - City:MILWAUKEE
Mailing Address - State:WI
Mailing Address - Zip Code:53226-4874
Mailing Address - Country:US
Mailing Address - Phone:414-266-6955
Mailing Address - Fax:414-266-1752
Practice Address - Street 1:9000 W WISCONSIN AVE
Practice Address - Street 2:PEDIATRIC UROLOGY
Practice Address - City:MILWAUKEE
Practice Address - State:WI
Practice Address - Zip Code:53226-4874
Practice Address - Country:US
Practice Address - Phone:414-266-6955
Practice Address - Fax:414-266-1752
Is Sole Proprietor?:No
Enumeration Date:2007-10-24
Last Update Date:2020-06-05
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WI136537363LP0200X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LP0200XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerPediatrics
Provider Identifiers
StateIdentifier IDID TypeIssuer
WI10223297264Medicaid
WI680860817Medicare PIN
WI736012071Medicare PIN