Individual
NICHOLE VIRGO
Active
Sole proprietor
No
Provider details
NPI number
Gender
F
Credential
APNP
Contact information
Practice address
8901 N 76TH ST FL 3, MILWAUKEE, WI 53223-1901
(414) 357-1307
(414) 365-0773
Mailing address
1225 W PINE CREEK CT, OAK CREEK, WI 53154-1833
(414) 745-5158
Taxonomy
Speciality
Code
Description
License number
State
208VP0014X
Interventional Pain Medicine Physician
148802
WI
363L00000X
Nurse Practitioner
3323-33
WI
363LF0000X
Family Nurse Practitioner
Primary
3323
WI
367A00000X
Advanced Practice Midwife
139386-30
WI
Other
Other identifiers
Code
Description
Identifier
Issuer
State
01
—
K400388476
MEDICARE
WI
01
—
V620-6377-9730-09
WI DRIVERS LICENSE #
WI
Enumeration date
09/20/2006
Last updated
05/02/2018
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