Healthcare Provider Details

I. General information

NPI: 1306199435
Provider Name (Legal Business Name): KATE M RATAJCZAK APNP
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 10/26/2012
Last Update Date: 05/12/2022
Certification Date: 05/12/2022
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1703 N TAYLOR DR
SHEBOYGAN WI
53081-1933
US

IV. Provider business mailing address

4425 N PORT WASHINGTON ROAD COLUMBIA ST MARY'S CLINIC CREDENTIALING
GLENDALE WI
53212-1082
US

V. Phone/Fax

Practice location:
  • Phone: 920-457-4438
  • Fax:
Mailing address:
  • Phone: 414-326-2378
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code363LF0000X
TaxonomyFamily Nurse Practitioner
License Number5088-33
License Number StateWI
# 2
Primary TaxonomyY
Taxonomy Code363L00000X
TaxonomyNurse Practitioner
License Number5088-33
License Number StateWI

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: