Individual
NICHOLAS PERIFANOS
Active
Sole proprietor
No
Provider details
NPI number
Gender
Man
Credential
NURSE PRACTITIONER
Contact information
Practice address
3289 N MAYFAIR RD, MILWAUKEE, WI 53222-3203
(414) 771-7900
Mailing address
PO BOX 735044, CHICAGO, IL 60673-5044
(800) 326-2250
Taxonomy
Speciality
Code
Description
License number
State
363L00000X
Nurse Practitioner
Primary
6840
WI
363LF0000X
Family Nurse Practitioner
6840-33
WI
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
100054438
—
WI
Enumeration date
02/24/2016
Last updated
02/27/2025
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