Provider Demographics
NPI:1609430396
Name:XIONG, SUE (APNP)
Entity type:Individual
Prefix:
First Name:SUE
Middle Name:
Last Name:XIONG
Suffix:
Gender:F
Credentials:APNP
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:3301 W FOREST HOME AVE
Mailing Address - Street 2:
Mailing Address - City:MILWAUKEE
Mailing Address - State:WI
Mailing Address - Zip Code:53215-2843
Mailing Address - Country:US
Mailing Address - Phone:920-434-3880
Mailing Address - Fax:920-434-3882
Practice Address - Street 1:464 CARDINAL LN
Practice Address - Street 2:
Practice Address - City:HOWARD
Practice Address - State:WI
Practice Address - Zip Code:54313-9569
Practice Address - Country:US
Practice Address - Phone:920-434-3880
Practice Address - Fax:920-434-3882
Is Sole Proprietor?:No
Enumeration Date:2019-04-28
Last Update Date:2021-11-24
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WI9067-33363LF0000X
WI9067363L00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363L00000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse Practitioner
No363LF0000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerFamily
Provider Identifiers
StateIdentifier IDID TypeIssuer
WI100092654Medicaid