Individual
NI THI MI CAO
Active
Sole proprietor
Yes
Provider details
NPI number
Gender
F
Credential
PA-C
Contact information
Practice address
725 AMERICAN AVE, WAUKESHA, WI 53188-5031
(262) 617-5663
Mailing address
2328 N 73RD ST, WAUWATOSA, WI 53213-1210
(262) 617-5663
Taxonomy
Speciality
Code
Description
License number
State
363A00000X
Physician Assistant
Primary
844923
WI
Other
Enumeration date
06/28/2023
Last updated
08/11/2025
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