Healthcare Provider Details

I. General information

NPI: 1033183058
Provider Name (Legal Business Name): MAUREEN R. KUGLITSCH APNP
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 02/15/2006
Last Update Date: 06/24/2013
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

COMMUNITY NURSING CLINIC AT WCTC 800 MAIN STREET ROOM SO173
PEWAUKEE WI
53072
US

IV. Provider business mailing address

WAUKESHA HEALTH CARE INC. N17 W24100 RIVERWOOD DRIVE SUITE 250
WAUKESHA WI
53188-1177
US

V. Phone/Fax

Practice location:
  • Phone: 262-695-1888
  • Fax: 262-695-1884
Mailing address:
  • Phone: 262-650-4100
  • Fax: 262-928-5835

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code363L00000X
TaxonomyNurse Practitioner
License Number273
License Number StateWI

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: