Healthcare Provider Details

I. General information

NPI: 1861071896
Provider Name (Legal Business Name): ANNY WICYK APNP
Entity Type: Individual
Gender: Female
Sole Proprietor: N

Provider Other Name: ANNY NGUYEN APNP

II. Dates (important events)

Enumeration Date: 04/06/2021
Last Update Date: 07/23/2025
Certification Date: 07/23/2025
Deactivation Date:
Reactivation Date:

III. Provider practice location address

BELOIT HEALTH SYSTEM 1969 WEST HART RD
BELOIT WI
53511-2283
US

IV. Provider business mailing address

BELOIT HEALTH SYSTEM 1969 WEST HART RD
BELOIT WI
53511-2283
US

V. Phone/Fax

Practice location:
  • Phone: 608-364-5689
  • Fax: 608-364-5452
Mailing address:
  • Phone: 608-364-5689
  • Fax: 608-364-5452

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code363L00000X
TaxonomyNurse Practitioner
License Number10837-33
License Number StateWI
# 2
Primary TaxonomyN
Taxonomy Code363LF0000X
TaxonomyFamily Nurse Practitioner
License Number10837-22
License Number StateWI

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: