Healthcare Provider Details

I. General information

NPI: 1326977299
Provider Name (Legal Business Name): ALEX A KOBYLARCZYK
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 05/18/2026
Last Update Date: 05/18/2026
Certification Date: 05/17/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

450 W MAPLE ST
STANLEY WI
54768-1097
US

IV. Provider business mailing address

450 W MAPLE ST
STANLEY WI
54768-1097
US

V. Phone/Fax

Practice location:
  • Phone: 920-600-7832
  • Fax:
Mailing address:
  • Phone:
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code163WS0200X
TaxonomySchool Registered Nurse
License Number228613-30
License Number StateWI

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: