Healthcare Provider Details

I. General information

NPI: 1639853211
Provider Name (Legal Business Name): KATHLEEN NICOLE SLUSARCZYK
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 06/14/2023
Last Update Date: 06/14/2023
Certification Date: 06/12/2023
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1271 N 6TH ST
MILWAUKEE WI
53212-3360
US

IV. Provider business mailing address

1129 N JACKSON ST APT 406
MILWAUKEE WI
53202-3279
US

V. Phone/Fax

Practice location:
  • Phone: 414-978-9100
  • Fax:
Mailing address:
  • Phone: 847-323-5013
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code363LF0000X
TaxonomyFamily Nurse Practitioner
License Number23654730
License Number StateWI

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: