Healthcare Provider Details

I. General information

NPI: 1598695074
Provider Name (Legal Business Name): ALYSSA LUEDTKE RN
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 05/19/2026
Last Update Date: 05/19/2026
Certification Date: 05/19/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

W172N8959 SHADY LN
MENOMONEE FALLS WI
53051-2096
US

IV. Provider business mailing address

N81W14701 FRANKLIN DR
MENOMONEE FALLS WI
53051-3907
US

V. Phone/Fax

Practice location:
  • Phone: 920-979-6059
  • Fax:
Mailing address:
  • Phone: 920-979-6059
  • Fax: 262-415-6050

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code163WS0200X
TaxonomySchool Registered Nurse
License Number1087067-30
License Number StateWI

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: