Healthcare Provider Details

I. General information

NPI: 1932080959
Provider Name (Legal Business Name): KERRY FICK CNS
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

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

III. Provider practice location address

1419 MARYGLADE DR
GRAFTON WI
53024-1214
US

IV. Provider business mailing address

1419 MARYGLADE DR
GRAFTON WI
53024-1214
US

V. Phone/Fax

Practice location:
  • Phone: 414-219-6070
  • Fax:
Mailing address:
  • Phone: 414-219-6070
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code364S00000X
TaxonomyClinical Nurse Specialist
License Number562
License Number StateWI

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: