Healthcare Provider Details

I. General information

NPI: 1265114961
Provider Name (Legal Business Name): KAITLIN ZURICK
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 08/02/2023
Last Update Date: 08/13/2025
Certification Date: 08/13/2025
Deactivation Date:
Reactivation Date:

III. Provider practice location address

N20W22961 WATERTOWN RD
WAUKESHA WI
53186-1308
US

IV. Provider business mailing address

N20W22961 WATERTOWN RD
WAUKESHA WI
53186-1308
US

V. Phone/Fax

Practice location:
  • Phone: 262-875-5070
  • Fax:
Mailing address:
  • Phone:
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code363LF0000X
TaxonomyFamily Nurse Practitioner
License Number34506
License Number StateTN

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: