Individual
PAUL FACCHIANO
Active
Sole proprietor
No
Provider details
NPI number
Gender
Man
Credential
NP
Contact information
Practice address
6609 W GREENFIELD AVE, WEST ALLIS, WI 53214-4958
(414) 257-8500
Mailing address
PO BOX 735044, CHICAGO, IL 60673-5044
Taxonomy
Speciality
Code
Description
License number
State
363L00000X
Nurse Practitioner
Primary
14138-33
WI
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
100261180
—
WI
Enumeration date
09/28/2023
Last updated
01/23/2024
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