Provider Demographics
NPI:1871974964
Name:RADULOVIC, TATYANA TRENDAFILOVA (FNP-BC)
Entity type:Individual
Prefix:
First Name:TATYANA
Middle Name:TRENDAFILOVA
Last Name:RADULOVIC
Suffix:
Gender:F
Credentials:FNP-BC
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Other - Credentials:
Mailing Address - Street 1:788 N JEFFERSON ST
Mailing Address - Street 2:SUITE 300/ATTN. KAAREN BUTZEN
Mailing Address - City:MILWAUKEE
Mailing Address - State:WI
Mailing Address - Zip Code:53202-3718
Mailing Address - Country:US
Mailing Address - Phone:414-272-8950
Mailing Address - Fax:414-272-0859
Practice Address - Street 1:2350 N LAKE DR
Practice Address - Street 2:SUITE 302
Practice Address - City:MILWAUKEE
Practice Address - State:WI
Practice Address - Zip Code:53211-4528
Practice Address - Country:US
Practice Address - Phone:414-298-7104
Practice Address - Fax:414-298-7117
Is Sole Proprietor?:No
Enumeration Date:2015-06-15
Last Update Date:2017-03-15
Deactivation Date:
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Provider Licenses
StateLicense IDTaxonomies
WI6391-33363LF0000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LF0000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerFamily
Provider Identifiers
StateIdentifier IDID TypeIssuer
WI1871974964Medicaid
WIK400252476Medicare PIN