Provider Demographics
NPI:1881268167
Name:NITZ, EMMA WEBER (CPNP-PC)
Entity type:Individual
Prefix:
First Name:EMMA
Middle Name:WEBER
Last Name:NITZ
Suffix:
Gender:F
Credentials:CPNP-PC
Other - Prefix:
Other - First Name:EMMA
Other - Middle Name:ALLEN
Other - Last Name:WEBER
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:
Mailing Address - Street 1:9000 W WISCONSIN AVE
Mailing Address - Street 2:
Mailing Address - City:MILWAUKEE
Mailing Address - State:WI
Mailing Address - Zip Code:53226-4874
Mailing Address - Country:US
Mailing Address - Phone:414-266-2090
Mailing Address - Fax:414-266-3157
Practice Address - Street 1:9000 W WISCONSIN AVE
Practice Address - Street 2:
Practice Address - City:MILWAUKEE
Practice Address - State:WI
Practice Address - Zip Code:53226-4874
Practice Address - Country:US
Practice Address - Phone:414-266-2090
Practice Address - Fax:414-266-3157
Is Sole Proprietor?:No
Enumeration Date:2021-05-19
Last Update Date:2022-07-06
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WI10509-33363LP0200X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LP0200XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerPediatrics