Basic Information
Provider Information
NPI: 1154772093
EntityType: 1
ReplacementNPI:  
OrganizationName:  
LastName: UEBERSOHN
FirstName: RACHEL
MiddleName: ELIZABETH
NamePrefix: MISS
NameSuffix:  
Credential: PA-C
OtherOrganizationName:  
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Mailing Information
Address1: 9200 W WISCONSIN AVE
Address2: DEPARTMENT OF INTERNAL MEDICINE
City: MILWAUKEE
State: WI
PostalCode: 532263522
CountryCode: US
TelephoneNumber: 4148056850
FaxNumber: 4148056851
Practice Location
Address1: 9200 W WISCONSIN AVE
Address2: DEPARTMENT OF INTERNAL MEDICINE
City: MILWAUKEE
State: WI
PostalCode: 532263522
CountryCode: US
TelephoneNumber: 4148056850
FaxNumber: 4148056851
Other Information
ProviderEnumerationDate: 06/22/2016
LastUpdateDate: 06/29/2016
NPIDeactivationReasonCode:  
NPIDeactivationDate:  
NPIReactivationDate:  
ProviderGenderCode: F
AuthorizedOfficialLastName:  
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AuthorizedOfficialTelephone:  
IsSoleProprietor: N
IsOrganizationSubpart:  
ParentOrganizationLBN:  
AuthorizedOfficialNamePrefix:  
AuthorizedOfficialNameSuffix:  
AuthorizedOfficialCredential:  
NPICertificationDate:  

Taxonomy Information
TaxonomyLicenseStateSwitchTaxonomyGroupTaxonomyTypeTaxonomyClassSubSpecialty
363A00000X3758-23WIY Physician Assistants & Advanced Practice Nursing ProvidersPhysician Assistant 

No ID Information.


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