Individual
SUSAN ELAINE THALLER
Active
Sole proprietor
No
Provider details
NPI number
Gender
F
Contact information
Practice address
2025 E NEWPORT AVE, MILWAUKEE, WI 53211-2906
(414) 229-7429
Mailing address
2025 E NEWPORT AVE, MILWAUKEE, WI 53211-2906
(414) 229-7429
(414) 229-4161
Taxonomy
Speciality
Code
Description
License number
State
363LF0000X
Family Nurse Practitioner
Primary
4582-033
WI
Other
Other identifiers
Code
Description
Identifier
Issuer
State
01
—
2011007053
AMERICAN NURSE CREDENTIALING CENTER
—
01
—
4582-033
WI DEPT OF REGULATION AND LICENSING
WI
Enumeration date
09/24/2011
Last updated
01/02/2025
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