Provider Demographics
NPI:1801953948
Name:PERSON, ANNE ANIA (NP, APNP)
Entity type:Individual
Prefix:MRS
First Name:ANNE ANIA
Middle Name:
Last Name:PERSON
Suffix:
Gender:F
Credentials:NP, APNP
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:10501 W RESEARCH DR STE G200
Mailing Address - Street 2:
Mailing Address - City:MILWAUKEE
Mailing Address - State:WI
Mailing Address - Zip Code:53226-3449
Mailing Address - Country:US
Mailing Address - Phone:414-543-3333
Mailing Address - Fax:
Practice Address - Street 1:10501 W RESEARCH DR STE G200
Practice Address - Street 2:
Practice Address - City:MILWAUKEE
Practice Address - State:WI
Practice Address - Zip Code:53226-3449
Practice Address - Country:US
Practice Address - Phone:414-543-3333
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2007-01-01
Last Update Date:2016-07-19
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WI3110363L00000X, 363LP0808X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363L00000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse Practitioner
No363LP0808XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerPsychiatric/Mental Health
Provider Identifiers
StateIdentifier IDID TypeIssuer
WI1801953948Medicaid
WI1256887OtherCAQH
WIK400231586Medicare PIN