Individual
JASON BRANDEIS
Active
Sole proprietor
No
Provider details
NPI number
Gender
Man
Contact information
Practice address
1220 DEWEY AVE, MILWAUKEE, WI 53213-2504
(414) 454-6600
Mailing address
1220 DEWEY AVE, MILWAUKEE, WI 53213-2504
Taxonomy
Speciality
Code
Description
License number
State
363L00000X
Nurse Practitioner
8701-33
WI
363LP0808X
Psychiatric/Mental Health Nurse Practitioner
Primary
8701-33
WI
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
100081512
—
WI
05
—
100081535
—
WI
Enumeration date
09/12/2018
Last updated
11/24/2021
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