Provider Demographics
NPI:1548511371
Name:CHIROFF, CALLIE JAE (ANP-BC)
Entity type:Individual
Prefix:
First Name:CALLIE
Middle Name:JAE
Last Name:CHIROFF
Suffix:
Gender:F
Credentials:ANP-BC
Other - Prefix:
Other - First Name:CALLIE
Other - Middle Name:JAE
Other - Last Name:SCHLICHT
Other - Suffix:
Other - Last Name Type:Other Name
Other - Credentials:ANP-BC
Mailing Address - Street 1:5434 W CAPITOL DR
Mailing Address - Street 2:UNIT 3
Mailing Address - City:MILWAUKEE
Mailing Address - State:WI
Mailing Address - Zip Code:53216-2298
Mailing Address - Country:US
Mailing Address - Phone:414-875-0505
Mailing Address - Fax:
Practice Address - Street 1:5434 W CAPITOL DR
Practice Address - Street 2:UNIT 3
Practice Address - City:MILWAUKEE
Practice Address - State:WI
Practice Address - Zip Code:53216-2298
Practice Address - Country:US
Practice Address - Phone:414-875-0505
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2012-09-19
Last Update Date:2023-06-05
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WI5003-33363LA2200X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LA2200XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerAdult Health
Provider Identifiers
StateIdentifier IDID TypeIssuer
WI1548511371Medicaid
WI1548511371Medicaid