Individual
DIANE M TRUDELL
Active
Sole proprietor
No
Provider details
NPI number
Gender
F
Credential
PAC
Contact information
Practice address
2900 W OKLAHOMA AVE, MILWAUKEE, WI 53215-4330
(414) 649-6588
(770) 237-1723
Mailing address
2900 W OKLAHOMA AVE, MILWAUKEE, WI 53215-4330
(414) 649-6588
(770) 237-1723
Taxonomy
Speciality
Code
Description
License number
State
363A00000X
Physician Assistant
Primary
505-023
WI
Other
Other identifiers
Code
Description
Identifier
Issuer
State
01
—
003
BCBS
WI
Enumeration date
05/04/2006
Last updated
11/30/2021
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