Provider Demographics
NPI:1902312507
Name:PASSEHL, PATRICIA (APNP, FNP-C)
Entity Type:Individual
Prefix:
First Name:PATRICIA
Middle Name:
Last Name:PASSEHL
Suffix:
Gender:F
Credentials:APNP, FNP-C
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:E7075 SEELEY CREEK RD
Mailing Address - Street 2:
Mailing Address - City:LOGANVILLE
Mailing Address - State:WI
Mailing Address - Zip Code:53943-9670
Mailing Address - Country:US
Mailing Address - Phone:608-963-6695
Mailing Address - Fax:
Practice Address - Street 1:E7075 SEELEY CREEK RD
Practice Address - Street 2:
Practice Address - City:LOGANVILLE
Practice Address - State:WI
Practice Address - Zip Code:53943-9670
Practice Address - Country:US
Practice Address - Phone:608-963-6695
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2017-12-18
Last Update Date:2020-01-26
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WI8166-33363L00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363L00000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse Practitioner