Provider Demographics
NPI:1750335204
Name:GASTRAU, KAREN L (APNP)
Entity type:Individual
Prefix:
First Name:KAREN
Middle Name:L
Last Name:GASTRAU
Suffix:
Gender:F
Credentials:APNP
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1185 KAVANAUGH PL
Mailing Address - Street 2:
Mailing Address - City:WAUWATOSA
Mailing Address - State:WI
Mailing Address - Zip Code:53213-3146
Mailing Address - Country:US
Mailing Address - Phone:414-476-2458
Mailing Address - Fax:
Practice Address - Street 1:5928 W VLIET ST
Practice Address - Street 2:SUITE 100A
Practice Address - City:MILWAUKEE
Practice Address - State:WI
Practice Address - Zip Code:53208-2165
Practice Address - Country:US
Practice Address - Phone:414-771-0212
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2006-05-20
Last Update Date:2021-11-19
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WI940363L00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363L00000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse Practitioner
Provider Identifiers
StateIdentifier IDID TypeIssuer
WI43859900Medicaid
WI43859900Medicaid