Provider Demographics
NPI:1306087242
Name:PERALES, DENISE M (APNP, CRNA)
Entity type:Individual
Prefix:
First Name:DENISE
Middle Name:M
Last Name:PERALES
Suffix:
Gender:F
Credentials:APNP, CRNA
Other - Prefix:
Other - First Name:DENISE
Other - Middle Name:M
Other - Last Name:MONDRAGON
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:RN
Mailing Address - Street 1:9200 W WISCONSIN AVE
Mailing Address - Street 2:
Mailing Address - City:MILWAUKEE
Mailing Address - State:WI
Mailing Address - Zip Code:53226-3522
Mailing Address - Country:US
Mailing Address - Phone:414-805-2715
Mailing Address - Fax:
Practice Address - Street 1:9200 W WISCONSIN AVE
Practice Address - Street 2:
Practice Address - City:MILWAUKEE
Practice Address - State:WI
Practice Address - Zip Code:53226-3522
Practice Address - Country:US
Practice Address - Phone:414-805-2715
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2009-03-23
Last Update Date:2025-01-23
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WI219409163W00000X
WI6026-33367500000X, 367500000X
WA176820163W00000X
WI219409-30367500000X
IL209013439367500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes367500000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse Anesthetist, Certified Registered
No163W00000XNursing Service ProvidersRegistered Nurse
Provider Identifiers
StateIdentifier IDID TypeIssuer
WI100301307Medicaid
WI1306087242Medicaid