Healthcare Provider Details

I. General information

NPI: 1134111917
Provider Name (Legal Business Name): VICKI MARTINEK APNP
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 08/18/2005
Last Update Date: 07/13/2026
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

270 E MARQUETTE ST
BERLIN WI
54923-1298
US

IV. Provider business mailing address

225 MEMORIAL DR
BERLIN WI
54923-1243
US

V. Phone/Fax

Practice location:
  • Phone: 920-361-5727
  • Fax: 920-361-5357
Mailing address:
  • Phone: 920-361-1313
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code163W00000X
TaxonomyRegistered Nurse
License Number52758-030
License Number StateWI
# 2
Primary TaxonomyN
Taxonomy Code363L00000X
TaxonomyNurse Practitioner
License Number769-033
License Number StateWI

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: