Provider Demographics
NPI:1114076544
Name:PAZDERA, EVA ANNE (ATC)
Entity type:Individual
Prefix:
First Name:EVA
Middle Name:ANNE
Last Name:PAZDERA
Suffix:
Gender:F
Credentials:ATC
Other - Prefix:
Other - First Name:EVA
Other - Middle Name:ANNE
Other - Last Name:BAETEN
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:ATC
Mailing Address - Street 1:1215 N 43RD ST
Mailing Address - Street 2:
Mailing Address - City:MILWAUKEE
Mailing Address - State:WI
Mailing Address - Zip Code:53208-2722
Mailing Address - Country:US
Mailing Address - Phone:146-072-6744
Mailing Address - Fax:
Practice Address - Street 1:2900 W OKLAHOMA AVE
Practice Address - Street 2:
Practice Address - City:MILWAUKEE
Practice Address - State:WI
Practice Address - Zip Code:53215-4330
Practice Address - Country:US
Practice Address - Phone:414-649-6383
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2007-01-08
Last Update Date:2024-07-23
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IL960021462255A2300X
WI1678-392255A2300X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes2255A2300XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersSpecialist/TechnologistAthletic Trainer