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General NPI Number Information
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NPI Number | 1447920079
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Entity Type | Individual
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Provider Name | KATHRYN BRUCATO
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Gender | Female
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Dates
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Enumeration Date | 09/15/2021
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Last Update Date | 11/16/2022
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Provider Practice Location Address
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Address Line | 120 CHAPMAN FARMS BLVD
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City | MUKWONAGO
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State | WI
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Zip | 53149-8877
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Country | US
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Telephone | 262-363-6160
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Fax |
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Provider Business Mailing Address
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Address Line | 120 CHAPMAN FARMS BLVD
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City | MUKWONAGO
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State | WI
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Zip | 53149-8877
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Country | US
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Telephone | 262-363-6160
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Fax | 262-363-6165
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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 | 363L00000X
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Taxonomy Name | Nurse Practitioner
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License Number | 22356
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License Number State | WI
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Taxonomy #2
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Taxonomy Code | 163W00000X
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Taxonomy Name | Registered Nurse
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License Number | 235153-30
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License Number State | WI
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Taxonomy #3
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Taxonomy Code | 363LP2300X
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Taxonomy Name | Primary Care Nurse Practitioner
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License Number | 22356-875
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License Number State | WI
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