Provider Demographics
NPI:1417310160
Name:CASADY, NICOLE (APNP)
Entity type:Individual
Prefix:MRS
First Name:NICOLE
Middle Name:
Last Name:CASADY
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 1:1155 N HONEY CREEK PKWY
Mailing Address - Street 2:
Mailing Address - City:WAUWATOSA
Mailing Address - State:WI
Mailing Address - Zip Code:53213-3189
Mailing Address - Country:US
Mailing Address - Phone:414-615-5900
Mailing Address - Fax:
Practice Address - Street 1:1155 N HONEY CREEK PKWY
Practice Address - Street 2:
Practice Address - City:WAUWATOSA
Practice Address - State:WI
Practice Address - Zip Code:53213-3189
Practice Address - Country:US
Practice Address - Phone:414-615-5900
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2016-03-31
Last Update Date:2021-11-30
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WI6855363L00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363L00000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse Practitioner
Provider Identifiers
StateIdentifier IDID TypeIssuer
WI100059296Medicaid