Provider Demographics
NPI:1306897814
Name:ANDRIS, DEBORAH A (MSN N)
Entity type:Individual
Prefix:MS
First Name:DEBORAH
Middle Name:A
Last Name:ANDRIS
Suffix:
Gender:F
Credentials:MSN N
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
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:414-805-5800
Mailing Address - Fax:414-890-5580
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:414-805-5800
Practice Address - Fax:414-890-5580
Is Sole Proprietor?:No
Enumeration Date:2006-05-12
Last Update Date:2012-10-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WI66138363LA2200X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LA2200XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerAdult Health
Provider Identifiers
StateIdentifier IDID TypeIssuer
000018515OOtherHUMANA
WI1306897814Medicaid
WI43881300Medicaid
0071H73601Medicare ID - Type Unspecified
WI1306897814Medicaid