Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 363LA2100X | Nurse Practitioner - Acute Care | 2702-033 | WI |
NPI | 1003870064 |
---|---|
Provider Name | Debra J Casper |
First Address | Hartland, WI 53029-9290 |
Second Address | Menomonee Falls, WI 53051-3518 |
Gender | F |
NPI Entity type | Individual |
Is Sole Proprietor | No |
Is Organization Subpart | N/A |
Enumeration Date | 14/04/2006 |
Last Update Date | 17/06/2015 |
IDENTIFIER | TYPE / CODE | IDENTIFIER STATE |
---|---|---|
Q60603 | (02) | WI |