Healthcare Provider Details

I. General information

NPI: 1730514175
Provider Name (Legal Business Name): NICOLE KATCHA APNP
Entity Type: Individual
Gender: Female
Sole Proprietor: N

Provider Other Name: NICOLE WIDULE RN

II. Dates (important events)

Enumeration Date: 09/04/2013
Last Update Date: 09/19/2013
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

20611 WATERTOWN RD SUITE J
WAUKESHA WI
53186-1871
US

IV. Provider business mailing address

20611 WATERTOWN RD SUITE J
WAUKESHA WI
53186-1871
US

V. Phone/Fax

Practice location:
  • Phone: 262-928-5900
  • Fax: 262-928-5925
Mailing address:
  • Phone: 262-928-5900
  • Fax: 262-928-5925

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code163WP2201X
TaxonomyAmbulatory Care Registered Nurse
License Number153059-30
License Number StateWI
# 2
Primary TaxonomyY
Taxonomy Code363LF0000X
TaxonomyFamily Nurse Practitioner
License Number5490-33
License Number StateWI

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: