Basic Information
| Provider Information | |||||||||
| NPI: | 1457822058 | ||||||||
| EntityType: | 1 | ||||||||
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| OrganizationName: | |||||||||
| LastName: | CONCEPCION | ||||||||
| FirstName: | JOHN | ||||||||
| MiddleName: | |||||||||
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| Credential: | FNP-BC | ||||||||
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| Mailing Information | |||||||||
| Address1: | 10200 W INNOVATION DR STE 400 | ||||||||
| Address2: | |||||||||
| City: | MILWAUKEE | ||||||||
| State: | WI | ||||||||
| PostalCode: | 532264826 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 4149442000 | ||||||||
| FaxNumber: | 4149442092 | ||||||||
| Practice Location | |||||||||
| Address1: | 10200 W INNOVATION DR STE 400 | ||||||||
| Address2: | |||||||||
| City: | MILWAUKEE | ||||||||
| State: | WI | ||||||||
| PostalCode: | 532264826 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 4149442000 | ||||||||
| FaxNumber: | 4149442092 | ||||||||
| Other Information | |||||||||
| ProviderEnumerationDate: | 12/08/2018 | ||||||||
| LastUpdateDate: | 05/12/2021 | ||||||||
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| ProviderGenderCode: | M | ||||||||
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| IsSoleProprietor: | N | ||||||||
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| NPICertificationDate: | 05/12/2021 | ||||||||
Taxonomy Information
| Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 363LF0000X | 8908 | WI | Y | Physician Assistants & Advanced Practice Nursing Providers | Nurse Practitioner | Family |
No ID Information.