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General NPI Number Information
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NPI Number | 1538736350
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Entity Type | Individual
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Provider Name | THERESA L WYCKLENDT APNP
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Gender | Female
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Dates
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Enumeration Date | 06/09/2021
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Last Update Date | 09/29/2025
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Provider Practice Location Address
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Address Line | 1000 BURR RIDGE PKWY STE 201
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City | BURR RIDGE
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State | IL
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Zip | 60527-0864
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Country | US
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Telephone | 312-818-4650
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Fax | 855-618-2629
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Provider Business Mailing Address
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Address Line | PO BOX 40412
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City | BELFAST
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State | ME
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Zip | 04915-1255
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Country | US
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Telephone | 312-818-4650
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Fax | 855-618-2629
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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 | 11060-033
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License Number State | WI
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Taxonomy #2
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Taxonomy Code | 363LC0200X
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Taxonomy Name | Critical Care Medicine Nurse Practitioner
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License Number | 1716711
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License Number State | WI
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