Provider Demographics
NPI:1104927227
Name:PAVLOVICH, BARBARA J (APNP)
Entity type:Individual
Prefix:
First Name:BARBARA
Middle Name:J
Last Name:PAVLOVICH
Suffix:
Gender:F
Credentials:APNP
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:5500 BROWN DEER ROAD
Mailing Address - Street 2:SUITE 100
Mailing Address - City:MILWAUKEE
Mailing Address - State:WI
Mailing Address - Zip Code:53223
Mailing Address - Country:US
Mailing Address - Phone:414-355-4300
Mailing Address - Fax:
Practice Address - Street 1:8923 W BROWN DEER RD
Practice Address - Street 2:
Practice Address - City:MILWAUKEE
Practice Address - State:WI
Practice Address - Zip Code:53224-2120
Practice Address - Country:US
Practice Address - Phone:414-355-4300
Practice Address - Fax:414-355-4608
Is Sole Proprietor?:No
Enumeration Date:2006-09-25
Last Update Date:2013-03-25
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WI801-033363LW0102X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LW0102XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerWomen's Health
Provider Identifiers
StateIdentifier IDID TypeIssuer
WI43921900OtherRAILROAD MEDICARE
WI392869763001OtherBCBS/COMPCARE
WI7417471OtherAETNA
WI0015-01140Medicare ID - Type Unspecified
WI7417471OtherAETNA