Provider Demographics
NPI:1295518520
Name:UHEN, MIRANDA (APNP, AGPCNP-BC)
Entity type:Individual
Prefix:
First Name:MIRANDA
Middle Name:
Last Name:UHEN
Suffix:
Gender:F
Credentials:APNP, AGPCNP-BC
Other - Prefix:
Other - First Name:MIRANDA
Other - Middle Name:
Other - Last Name:REINKE
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:
Mailing Address - Street 1:N8653 WILMERS GROVE RD
Mailing Address - Street 2:
Mailing Address - City:EAST TROY
Mailing Address - State:WI
Mailing Address - Zip Code:53120-2018
Mailing Address - Country:US
Mailing Address - Phone:262-822-7208
Mailing Address - Fax:
Practice Address - Street 1:10200 W INNOVATION DR STE 400
Practice Address - Street 2:
Practice Address - City:MILWAUKEE
Practice Address - State:WI
Practice Address - Zip Code:53226-4826
Practice Address - Country:US
Practice Address - Phone:866-216-5708
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2023-08-18
Last Update Date:2023-08-18
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WI14404-33363LP2300X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LP2300XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerPrimary Care