Healthcare Provider Details

I. General information

NPI: 1538031588
Provider Name (Legal Business Name): TYLER D ADAMCZAK APNP
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 09/19/2025
Last Update Date: 12/10/2025
Certification Date: 12/10/2025
Deactivation Date:
Reactivation Date:

III. Provider practice location address

855 LAKELAND DR
CHIPPEWA FALLS WI
54729-1687
US

IV. Provider business mailing address

2403A FOLSOM ST
EAU CLAIRE WI
54703-2435
US

V. Phone/Fax

Practice location:
  • Phone: 715-726-9248
  • Fax:
Mailing address:
  • Phone:
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code363LF0000X
TaxonomyFamily Nurse Practitioner
License Number17611-33
License Number StateWI

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: