Provider Demographics
NPI:1356516504
Name:CITY OF WAUWATOSA HEALTH DEPARTMENT
Entity type:Organization
Organization Name:CITY OF WAUWATOSA HEALTH DEPARTMENT
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:CITY OF WAUWATOSA HEALTH OFFICER
Authorized Official - Prefix:DR
Authorized Official - First Name:NANCY
Authorized Official - Middle Name:JEAN
Authorized Official - Last Name:KREUSER
Authorized Official - Suffix:
Authorized Official - Credentials:RN, PHD
Authorized Official - Phone:414-479-8940
Mailing Address - Street 1:7725 W NORTH AVE
Mailing Address - Street 2:
Mailing Address - City:WAUWATOSA
Mailing Address - State:WI
Mailing Address - Zip Code:53213-1720
Mailing Address - Country:US
Mailing Address - Phone:414-479-8940
Mailing Address - Fax:414-471-8483
Practice Address - Street 1:7725 W NORTH AVE
Practice Address - Street 2:
Practice Address - City:WAUWATOSA
Practice Address - State:WI
Practice Address - Zip Code:53213-1720
Practice Address - Country:US
Practice Address - Phone:414-479-8940
Practice Address - Fax:414-471-8483
EIN:<UNAVAIL>
Is Organization Subpart?:Yes
Parent Organization LBN:CITY OF WAUWATOSA
Parent Organization TIN:<UNAVAIL>
Enumeration Date:2008-04-29
Last Update Date:2008-04-29
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WI9666530251K00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes251K00000XAgenciesPublic Health or Welfare
Provider Identifiers
StateIdentifier IDID TypeIssuer
WI43083500Medicaid
WI1427184357Medicare UPIN