Individual
JULIE PENDERGAST
Active
Sole proprietor
No
Provider details
NPI number
Gender
F
Credential
RN
Contact information
Practice address
11390 W THEODORE TRECKER WAY, WEST MILWAUKEE, WI 53214-1135
(414) 928-1401
(414) 328-1402
Mailing address
11390 W THEODORE TRECKER WAY, WEST MILWAUKEE, WI 53214-1135
(414) 928-1401
(414) 328-1402
Taxonomy
Speciality
Code
Description
License number
State
163W00000X
Registered Nurse
221281-30
WI
163WA0400X
Addiction (Substance Use Disorder) Registered Nurse
Primary
221282
WI
Other
Enumeration date
07/31/2014
Last updated
09/23/2020
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