Healthcare Provider Details

I. General information

NPI: 1245925395
Provider Name (Legal Business Name): NICOLE LESTENCIA BJERKE APNP
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 04/05/2023
Last Update Date: 04/05/2023
Certification Date: 04/05/2023
Deactivation Date:
Reactivation Date:

III. Provider practice location address

18601 LINCOLN ST
WHITEHALL WI
54773-8605
US

IV. Provider business mailing address

18601 LINCOLN ST
WHITEHALL WI
54773-8605
US

V. Phone/Fax

Practice location:
  • Phone: 715-538-1712
  • Fax:
Mailing address:
  • Phone: 715-538-1712
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code363LF0000X
TaxonomyFamily Nurse Practitioner
License Number13572
License Number StateWI

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: