Provider Demographics
NPI:1982565628
Name:CARDOSA, DEIRDRE LOUISE (PMHNP)
Entity type:Individual
Prefix:
First Name:DEIRDRE
Middle Name:LOUISE
Last Name:CARDOSA
Suffix:
Gender:F
Credentials:PMHNP
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:559 WILD OAK RD
Mailing Address - Street 2:
Mailing Address - City:HARTLAND
Mailing Address - State:WI
Mailing Address - Zip Code:53029-1217
Mailing Address - Country:US
Mailing Address - Phone:
Mailing Address - Fax:
Practice Address - Street 1:559 WILD OAK RD
Practice Address - Street 2:
Practice Address - City:HARTLAND
Practice Address - State:WI
Practice Address - Zip Code:53029-1217
Practice Address - Country:US
Practice Address - Phone:414-902-3852
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2025-11-21
Last Update Date:2025-11-25
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WI2025066297363LP0808X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LP0808XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerPsychiatric/Mental Health