Provider Demographics
NPI:1265093348
Name:LANDGRAF, ERICA M (NP)
Entity type:Individual
Prefix:
First Name:ERICA
Middle Name:M
Last Name:LANDGRAF
Suffix:
Gender:F
Credentials:NP
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:8010 S VERDEV DR
Mailing Address - Street 2:
Mailing Address - City:OAK CREEK
Mailing Address - State:WI
Mailing Address - Zip Code:53154-3040
Mailing Address - Country:US
Mailing Address - Phone:414-687-6904
Mailing Address - Fax:
Practice Address - Street 1:8585 W FOREST HOME AVE STE 200
Practice Address - Street 2:
Practice Address - City:GREENFIELD
Practice Address - State:WI
Practice Address - Zip Code:53228-3467
Practice Address - Country:US
Practice Address - Phone:414-529-8500
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2019-06-27
Last Update Date:2021-10-13
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WI8878363LF0000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LF0000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerFamily