Healthcare Provider Details

I. General information

NPI: 1578894382
Provider Name (Legal Business Name): MICHELE PAOLI APNP
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 01/18/2010
Last Update Date: 09/09/2024
Certification Date: 09/09/2024
Deactivation Date:
Reactivation Date:

III. Provider practice location address

986 WIANECKI RD
KRONENWETTER WI
54455-8407
US

IV. Provider business mailing address

986 WIANECKI RD
KRONENWETTER WI
54455-8407
US

V. Phone/Fax

Practice location:
  • Phone: 715-551-1256
  • Fax:
Mailing address:
  • Phone: 715-551-1256
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code163W00000X
TaxonomyRegistered Nurse
License Number119334030
License Number StateWI
# 2
Primary TaxonomyY
Taxonomy Code363LP0808X
TaxonomyPsychiatric/Mental Health Nurse Practitioner
License Number1538533
License Number StateWI

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: