Healthcare Provider Details

I. General information

NPI: 1376943803
Provider Name (Legal Business Name): KATIE L PRUCHA APNP
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 09/03/2014
Last Update Date: 06/23/2026
Certification Date: 06/23/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

W165N5595 CREEKWOOD XING
MENOMONEE FALLS WI
53051-0685
US

IV. Provider business mailing address

W244N5706 FALCON DR
SUSSEX WI
53089-5056
US

V. Phone/Fax

Practice location:
  • Phone: 262-252-1050
  • Fax:
Mailing address:
  • Phone: 920-242-6960
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code363LF0000X
TaxonomyFamily Nurse Practitioner
License Number5980-33
License Number StateWI
# 2
Primary TaxonomyN
Taxonomy Code363LF0000X
TaxonomyFamily Nurse Practitioner
License Number174355
License Number StateWI

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: