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General NPI Number Information
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NPI Number | 1396432704
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Entity Type | Individual
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Provider Name | DANIELLE ELIZABETH KOZICZKOWSKI
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Gender | Female
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Dates
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Enumeration Date | 04/18/2023
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Last Update Date | 05/22/2025
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Provider Practice Location Address
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Address Line | 4935 S 76TH ST
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City | GREENFIELD
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State | WI
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Zip | 53220-9900
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Country | US
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Telephone | 414-777-3100
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Fax |
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Provider Business Mailing Address
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Address Line | 1851 BLACKFOOT AVE
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City | GRAFTON
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State | WI
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Zip | 53024-9303
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Country | US
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Telephone | 262-305-3285
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Fax | 414-260-7345
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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 | 363A00000X
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Taxonomy Name | Physician Assistant
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License Number | 8060
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License Number State | WI
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