Provider Demographics
NPI:1932203932
Name:MISSALL, PATRICIA L (NP)
Entity Type:Individual
Prefix:
First Name:PATRICIA
Middle Name:L
Last Name:MISSALL
Suffix:
Gender:F
Credentials:NP
Other - Prefix:
Other - First Name:
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Other - Last Name:
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Other - Credentials:
Mailing Address - Street 1:3077 N MAYFAIR RD STE 305
Mailing Address - Street 2:
Mailing Address - City:WAUWATOSA
Mailing Address - State:WI
Mailing Address - Zip Code:53222-4305
Mailing Address - Country:US
Mailing Address - Phone:414-384-6700
Mailing Address - Fax:414-727-1058
Practice Address - Street 1:3237 S 16TH ST
Practice Address - Street 2:SUITE 210
Practice Address - City:MILWAUKEE
Practice Address - State:WI
Practice Address - Zip Code:53215-4526
Practice Address - Country:US
Practice Address - Phone:414-384-6700
Practice Address - Fax:414-384-3008
Is Sole Proprietor?:No
Enumeration Date:2006-09-11
Last Update Date:2020-02-25
Deactivation Date:
Deactivation Code:
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Provider Licenses
StateLicense IDTaxonomies
WI223933363L00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363L00000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse Practitioner
Provider Identifiers
StateIdentifier IDID TypeIssuer
WI43982500Medicaid
P86123Medicare UPIN
WI43982500Medicaid