Provider Demographics
NPI:1154515104
Name:ESSUMAN, ALBERTA B (APNP)
Entity type:Individual
Prefix:
First Name:ALBERTA
Middle Name:B
Last Name:ESSUMAN
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 1:2511 W MARGARETTA CT
Mailing Address - Street 2:
Mailing Address - City:GLENDALE
Mailing Address - State:WI
Mailing Address - Zip Code:53209-2025
Mailing Address - Country:US
Mailing Address - Phone:414-247-1557
Mailing Address - Fax:
Practice Address - Street 1:8500 W CAPITOL DR STE 100
Practice Address - Street 2:
Practice Address - City:MILWAUKEE
Practice Address - State:WI
Practice Address - Zip Code:53222-1869
Practice Address - Country:US
Practice Address - Phone:414-431-5004
Practice Address - Fax:414-431-2959
Is Sole Proprietor?:No
Enumeration Date:2007-09-04
Last Update Date:2019-02-05
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WI3201363L00000X
WI3201-33363LF0000X
WI320133207P00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LF0000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerFamily
No363L00000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse Practitioner
No207P00000XAllopathic & Osteopathic PhysiciansEmergency Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
WI029050148Medicare PIN
WI014730087Medicare PIN