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Individual

IVANA SPACIEL

Active
Sole proprietor
No

Provider details

NPI number
Gender
F
Credential
APN

Contact information

Practice address
1220 DEWEY AVE, WAUWATOSA, WI 53213-2504
(414) 773-4312
Mailing address
1220 DEWEY AVE, WAUWATOSA, WI 53213-2504
(414) 773-4312

Taxonomy

Speciality
Code
Description
License number
State
363L00000X
Nurse Practitioner
8836
WI
363LP0808X
Psychiatric/Mental Health Nurse Practitioner
209017238
IL
363LP0808X
Psychiatric/Mental Health Nurse Practitioner
Primary
8836
WI

Other

Other identifiers
Code
Description
Identifier
Issuer
State
05
100084203
WI
05
100084205
WI
Enumeration date
02/08/2018
Last updated
11/24/2021
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