Individual
MS. BARBARA J. PROVO
Active
Sole proprietor
No
Provider details
NPI number
Gender
F
Credential
APNP
Contact information
Practice address
9200 W WISCONSIN AVE, VASCULAR SURGERY, MILWAUKEE, WI 53226-3522
(414) 805-3902
(414) 805-8514
Mailing address
9200 W WISCONSIN AVE, VASCULAR SURGERY, MILWAUKEE, WI 53226-3522
(414) 805-3902
(414) 805-8514
Taxonomy
Speciality
Code
Description
License number
State
363LF0000X
Family Nurse Practitioner
Primary
3604
WI
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
1992944300
—
WI
Enumeration date
02/09/2009
Last updated
08/03/2012
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