Individual
MYRRA JEAN WINDAU
Active
Sole proprietor
No
Provider details
NPI number
Gender
F
Credential
PA-C
Contact information
Practice address
9200 W WISCONSIN AVE, DIVISION OF ENDOCRINOLOGY, MILWAUKEE, WI 53226-3522
(414) 805-6550
(414) 805-6565
Mailing address
9200 W WISCONSIN AVE, DIVISION OF ENDOCRINOLOGY, MILWAUKEE, WI 53226-3522
(414) 805-6550
(414) 805-6565
Taxonomy
Speciality
Code
Description
License number
State
363A00000X
Physician Assistant
Primary
2714-23
WI
363A00000X
Physician Assistant
PA60180632
WA
Other
Other identifiers
Code
Description
Identifier
Issuer
State
01
—
1092932
NCCPA CERTIFICATION
—
05
—
1275830028
—
WI
01
—
2714-23
WISCONSIN STATE PHYSICIAN ASSISTANT LICENSE
WI
01
—
PA60180632
WASHINGTON STATE PHYSICIAN ASSISTANT LICENSE
WA
Enumeration date
02/14/2011
Last updated
11/09/2012
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