Provider Demographics
NPI:1780951996
Name:HALE, ANTHONY L (DNP, PMHNP-BC,FNP-BC)
Entity type:Individual
Prefix:DR
First Name:ANTHONY
Middle Name:L
Last Name:HALE
Suffix:
Gender:M
Credentials:DNP, PMHNP-BC,FNP-BC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:2113 TALLGRASS CIR
Mailing Address - Street 2:
Mailing Address - City:WAUKESHA
Mailing Address - State:WI
Mailing Address - Zip Code:53188-2606
Mailing Address - Country:US
Mailing Address - Phone:262-527-9798
Mailing Address - Fax:
Practice Address - Street 1:8532 W CAPITOL DR STE 201
Practice Address - Street 2:
Practice Address - City:MILWAUKEE
Practice Address - State:WI
Practice Address - Zip Code:53222-1850
Practice Address - Country:US
Practice Address - Phone:414-446-1040
Practice Address - Fax:414-435-9638
Is Sole Proprietor?:Yes
Enumeration Date:2011-11-17
Last Update Date:2021-04-20
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WI4697363LF0000X, 363LP0808X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LP0808XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerPsychiatric/Mental Health
No363LF0000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerFamily
Provider Identifiers
StateIdentifier IDID TypeIssuer
WI1932503240Medicaid
WI1780951996Medicaid