Provider Demographics
NPI:1063470581
Name:ERTL, TAMMY L (NP)
Entity type:Individual
Prefix:MRS
First Name:TAMMY
Middle Name:L
Last Name:ERTL
Suffix:
Gender:F
Credentials:NP
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Other - Credentials:
Mailing Address - Street 1:7400 W RAWSON AVE
Mailing Address - Street 2:SUITE 120
Mailing Address - City:FRANKLIN
Mailing Address - State:WI
Mailing Address - Zip Code:53132
Mailing Address - Country:US
Mailing Address - Phone:414-409-1000
Mailing Address - Fax:414-409-1019
Practice Address - Street 1:7400 W RAWSON AVE
Practice Address - Street 2:SUITE 120
Practice Address - City:FRANKLIN
Practice Address - State:WI
Practice Address - Zip Code:53132
Practice Address - Country:US
Practice Address - Phone:414-409-1000
Practice Address - Fax:414-409-1019
Is Sole Proprietor?:Not Answered
Enumeration Date:2006-05-03
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
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Provider Licenses
StateLicense IDTaxonomies
WI1941033207V00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207V00000XAllopathic & Osteopathic PhysiciansObstetrics & Gynecology