Healthcare Provider Details

I. General information

NPI: 1366137333
Provider Name (Legal Business Name): MICHAELA MACHURICK ACNPC-AG
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 04/06/2023
Last Update Date: 12/21/2023
Certification Date: 12/06/2023
Deactivation Date:
Reactivation Date:

III. Provider practice location address

5045 W GRANDE MARKET DR
APPLETON WI
54913-8517
US

IV. Provider business mailing address

301 W 17TH ST
KAUKAUNA WI
54130-3105
US

V. Phone/Fax

Practice location:
  • Phone: 920-886-9380
  • Fax:
Mailing address:
  • Phone: 920-809-8696
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code363L00000X
TaxonomyNurse Practitioner
License Number13685-33
License Number StateWI

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: