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Emily A Staszak

Nurse Practitioner

Physician Assistants & Advanced Practice Nursing Providers

2801 W Kinnickinnic River Pkwy, Ste 165, Milwaukee, WI 53215

PECOS Enrollment

This provider is enrolled in PECOS as EMILY STASZAK.

Based on the most recent information from CMS, provider Emily A Staszak is legally eligible to order and refer claims for Part B, HHA, DME and PMD services.

Part B
Medicare Part B
Enrolled
HHA
Home Health Agency
Enrolled
DME
Durable Medical Equipment
Enrolled
PMD
Power Mobility Device
Enrolled

CMS last updated its PECOS records 2 days ago.

Profile Details

Provider ID
1366878100
Provider Type
Individual
Full Name
Staszak, Emily A
Credential
NP

Gender
Female
Sole Proprietor
No
Enumeration Date
9/25/2013
Last Updated
11/24/2021

Contact Information

Practice Location

2801 W Kinnickinnic River Pkwy, Ste 165, Milwaukee, WI 53215

(414) 385-2301

Unlisted Fax

Mailing Location

2901 W Kinnickinnic River Pkwy Ste 305, Milwaukee, WI 53215-3660

(414) 385-5999

(414) 385-5990

Provider Taxonomies

Code	Description	License
Code 363L00000X Primary	Description Nurse Practitioner Physician Assistants & Advanced Practice Nursing Providers	License 5500 Wisconsin
Code 363LF0000X	Description Nurse Practitioner Physician Assistants & Advanced Practice Nursing Providers	License 5500 Wisconsin

Provider Identifiers

ID	Description	Issuer
ID 100032965	Description Medicaid	Issuer Unlisted Wisconsin

Emily A Staszak

PECOS Enrollment

Profile Details

Contact Information

Practice Location

Mailing Location

Provider Taxonomies

Code

Description

License

Code

Description

License

Code

Description

License

Provider Identifiers

ID

Description

Issuer

ID

Description

Issuer

Eilers, Sarah

Masaka, Kimiyo M

Reich, Michael Scott

Villegas, Maria A

Sullivan, Stacey Allysun

Colton, Miriam

Del Gaudio, Leah Marie

Szudrowitz Warner, Danielle K

Camosy, Nicole

Murray, Jennifer M