Provider Demographics
NPI:1154828226
Name:ROMERO RIVERA, MISTY M (APNP)
Entity type:Individual
Prefix:
First Name:MISTY
Middle Name:M
Last Name:ROMERO RIVERA
Suffix:
Gender:
Credentials:APNP
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Other - First Name:
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Other - Credentials:
Mailing Address - Street 1:7974 UW HEALTH CT
Mailing Address - Street 2:
Mailing Address - City:MIDDLETON
Mailing Address - State:WI
Mailing Address - Zip Code:53562-5531
Mailing Address - Country:US
Mailing Address - Phone:
Mailing Address - Fax:
Practice Address - Street 1:109 WARREN ST STE 4
Practice Address - Street 2:
Practice Address - City:BEAVER DAM
Practice Address - State:WI
Practice Address - Zip Code:53916-3082
Practice Address - Country:US
Practice Address - Phone:608-915-0150
Practice Address - Fax:608-203-1027
Is Sole Proprietor?:No
Enumeration Date:2018-04-06
Last Update Date:2025-04-15
Deactivation Date:
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Provider Licenses
StateLicense IDTaxonomies
WI8307-33363LF0000X, 363LP0200X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LP0200XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerPediatrics
No363LF0000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerFamily