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General NPI Number Information
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NPI Number | 1154192623
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Entity Type | Individual
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Provider Name | ALEXANDRA L WIDENSKI
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Gender | Female
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Dates
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Enumeration Date | 01/12/2024
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Last Update Date | 10/04/2024
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Provider Practice Location Address
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Address Line | 11101 W LINCOLN AVE
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City | MILWAUKEE
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State | WI
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Zip | 53227-1133
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Country | US
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Telephone | 800-767-4411
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Fax |
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Provider Business Mailing Address
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Address Line | 34700 VALLEY RD
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City | OCONOMOWOC
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State | WI
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Zip | 53066-4500
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Country | US
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Telephone | 262-646-4411
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Fax |
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Authorized Official
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Title or Position |
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Name |
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Credential |
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Telephone |
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 163WP0809X
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Taxonomy Name | Adult Psychiatric/Mental Health Registered Nurse
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License Number | 253228-30
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License Number State | WI
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Taxonomy #2
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Taxonomy Code | 363LP0808X
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Taxonomy Name | Psychiatric/Mental Health Nurse Practitioner
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License Number | 15724-33
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License Number State | WI
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