Healthcare Provider Details

I. General information

NPI: 1851808059
Provider Name (Legal Business Name): ALLISON DANIELLE KACZMAREK APNP
Entity Type: Individual
Gender: Female
Sole Proprietor: N

Provider Other Name: ALLISON DANIELLE BERG

II. Dates (important events)

Enumeration Date: 01/09/2018
Last Update Date: 01/09/2018
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1700 W PARADISE DR
WEST BEND WI
53095-9795
US

IV. Provider business mailing address

2761 N WEIL ST
MILWAUKEE WI
53212-2617
US

V. Phone/Fax

Practice location:
  • Phone: 262-334-3451
  • Fax:
Mailing address:
  • Phone: 310-266-0398
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code363L00000X
TaxonomyNurse Practitioner
License Number8204-33
License Number StateWI

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: