Individual
KEITH DALLENBACH JR.
Active
Sole proprietor
No
Provider details
NPI number
Gender
Man
Credential
RN, ACNPC-AG
Contact information
Practice address
9200 W WISCONSIN AVE, INFECTIOUS DISEASES, MILWAUKEE, WI 53226-3522
(414) 805-0746
(414) 805-0748
Mailing address
9200 W WISCONSIN AVE, INFECTIOUS DISEASES, MILWAUKEE, WI 53226-3522
(414) 805-0746
(414) 805-0748
Taxonomy
Speciality
Code
Description
License number
State
363LA2100X
Acute Care Nurse Practitioner
Primary
179816
WI
Other
Enumeration date
08/07/2015
Last updated
08/14/2015
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