Provider Demographics
NPI:1528086220
Name:ROHDE, DAVID J (PHD PMHCNS-BC)
Entity type:Individual
Prefix:DR
First Name:DAVID
Middle Name:J
Last Name:ROHDE
Suffix:
Gender:M
Credentials:PHD PMHCNS-BC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
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Other - Credentials:
Mailing Address - Street 1:2717 N GRANDVIEW BLVD
Mailing Address - Street 2:SUITE 202
Mailing Address - City:WAUKESHA
Mailing Address - State:WI
Mailing Address - Zip Code:53188-1672
Mailing Address - Country:US
Mailing Address - Phone:262-513-0700
Mailing Address - Fax:262-513-0707
Practice Address - Street 1:2717 N GRANDVIEW BLVD
Practice Address - Street 2:SUITE 202
Practice Address - City:WAUKESHA
Practice Address - State:WI
Practice Address - Zip Code:53188-1672
Practice Address - Country:US
Practice Address - Phone:262-513-0700
Practice Address - Fax:262-513-0707
Is Sole Proprietor?:No
Enumeration Date:2006-07-18
Last Update Date:2023-03-07
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WI101665030163WP0809X
WI3485-33364SP0808X
WI348533363L00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363L00000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse Practitioner
No163WP0809XNursing Service ProvidersRegistered NursePsychiatric/Mental Health, Adult
No364SP0808XPhysician Assistants & Advanced Practice Nursing ProvidersClinical Nurse SpecialistPsychiatric/Mental Health
Provider Identifiers
StateIdentifier IDID TypeIssuer
WI39403800Medicaid
WI3485-33OtherADVANCED PRACTICE NURSE PRESCRIBER
WI0235018-01OtherAMERICAN NURSES CREDENTIALING CENTER
WI686150018OtherMEDICARE
WI686150018OtherMEDICARE
WI39403800Medicaid