Provider Demographics
NPI:1306288030
Name:HAUSLER, ANNA L (PAC)
Entity type:Individual
Prefix:
First Name:ANNA
Middle Name:L
Last Name:HAUSLER
Suffix:
Gender:F
Credentials:PAC
Other - Prefix:
Other - First Name:ANNA
Other - Middle Name:L
Other - Last Name:WYSOCKI
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:PAC
Mailing Address - Street 1:9200 W WISCONSIN AVE
Mailing Address - Street 2:GENERAL SURGERY
Mailing Address - City:MILWAUKEE
Mailing Address - State:WI
Mailing Address - Zip Code:53226-3522
Mailing Address - Country:US
Mailing Address - Phone:414-805-5700
Mailing Address - Fax:414-259-9225
Practice Address - Street 1:9200 W WISCONSIN AVE
Practice Address - Street 2:GENERAL SURGERY
Practice Address - City:MILWAUKEE
Practice Address - State:WI
Practice Address - Zip Code:53226-3522
Practice Address - Country:US
Practice Address - Phone:414-805-5700
Practice Address - Fax:414-259-9225
Is Sole Proprietor?:No
Enumeration Date:2013-07-23
Last Update Date:2014-09-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WI3122-23363A00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363A00000XPhysician Assistants & Advanced Practice Nursing ProvidersPhysician Assistant
Provider Identifiers
StateIdentifier IDID TypeIssuer
WI1306288030Medicaid
WIK400094050Medicare PIN
WI1306288030Medicaid