Healthcare Provider Details

I. General information

NPI: 1639951684
Provider Name (Legal Business Name): ALEXANDRIA DYSZELSKI RN
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 10/16/2023
Last Update Date: 10/16/2023
Certification Date: 10/16/2023
Deactivation Date:
Reactivation Date:

III. Provider practice location address

2422 N GRANDVIEW BLVD
WAUKESHA WI
53188-6105
US

IV. Provider business mailing address

3477 S AHMEDI AVE
MILWAUKEE WI
53207-3638
US

V. Phone/Fax

Practice location:
  • Phone: 262-549-6600
  • Fax:
Mailing address:
  • Phone: 414-779-1115
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code163W00000X
TaxonomyRegistered Nurse
License Number1101735-30
License Number StateWI

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: