Healthcare Provider Details

I. General information

NPI: 1720851496
Provider Name (Legal Business Name): CHRISTINE NICOLE LUNOWA APNP
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 11/03/2023
Last Update Date: 02/12/2024
Certification Date: 02/12/2024
Deactivation Date:
Reactivation Date:

III. Provider practice location address

2301 N LAKE DR
MILWAUKEE WI
53211-4508
US

IV. Provider business mailing address

19475 W NORTH AVE
BROOKFIELD WI
53045-4199
US

V. Phone/Fax

Practice location:
  • Phone: 262-928-1000
  • Fax:
Mailing address:
  • Phone: 262-689-1952
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code363LA2100X
TaxonomyAcute Care Nurse Practitioner
License Number14857-33
License Number StateWI
# 2
Primary TaxonomyN
Taxonomy Code363LC0200X
TaxonomyCritical Care Medicine Nurse Practitioner
License Number14857-33
License Number StateWI

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: