Healthcare Provider Details

I. General information

NPI: 1104790427
Provider Name (Legal Business Name): CHRISTINE ANN MALECHEK NP
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 09/30/2025
Last Update Date: 08/17/2026
Certification Date: 08/17/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

2366 OAK RIDGE CIR
DE PERE WI
54115-9207
US

IV. Provider business mailing address

3302 W ZANDER RD
DENMARK WI
54208-9506
US

V. Phone/Fax

Practice location:
  • Phone: 920-338-1111
  • Fax: 920-339-5506
Mailing address:
  • Phone:
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code363LG0600X
TaxonomyGerontology Nurse Practitioner
License Number17467-33
License Number StateWI

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: