Provider records sourced from NPPES (CMS National Plan & Provider Enumeration System). Data current as of August 10, 2026.
NPIDirectory

Tara R Donnelly

Individual provider Registered Nurse · NPI 1104535038

Tara R Donnelly is a Nurse Practitioner in Milwaukee, Wisconsin. Qualified in 2022, 4 years ago. Practices with The Medical College of Wisconsin Inc, a 2,093-clinician group and accepts Medicare assignment. Licensed in Wisconsin.

Years since qualifying
4
Licensed in
WI
In the registry since
2022
Specialties on file
2
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Practice location Address checks out

9200 W Wisconsin Ave
Milwaukee, WI 53226-3522
Phone: (414) 955-1700
Fax: (414) 955-0072
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Pin is approximate — placed at the ZIP-code centre, not the exact door.

Specialties & licences

Nurse Practitioner (primary) Taxonomy 363L00000X · Licence 13463-33 (WI)
Registered Nurse Taxonomy 163W00000X · Licence 171290 (WI)

Record details

NPI number1104535038
Entity typeIndividual (Type 1)
GenderFemale
Sole proprietorNo
NPI enumeratedNovember 18, 2022
Last updated in NPPESJanuary 30, 2023
Certification dateJanuary 30, 2023

Medicare enrollment

From the CMS Doctors & Clinicians file — this clinician is enrolled in Medicare.

Medicare specialtyNURSE PRACTITIONER
Medical schoolOTHER
Graduated 2022 (4 years in practice)
Group practice The Medical College Of Wisconsin Inc — 2093 clinicians
Accepts Medicare assignment Yes — accepts the Medicare-approved amount
Practice locations2 on file with Medicare

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