MEDICARE: KATHLEEN L LUDWIKOWSKI

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	363LP0200X	Pediatric Nurse Practitioner	4688-33	WI
2	363LP0808X	Psychiatric/Mental Health Nurse Practitioner	4688-33	WI

General Provider Information

NPI Number	:	1073506119
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	KATHLEEN L LUDWIKOWSKI

Provider Business Mailing Address
First Line	:	N5427 COUNTY ROAD Y
Second Line	:
City	:	MONTELLO
State	:	WI
Zip	:	53949-8307
Country	:	US
Telephone Number	:	608-297-9680
Fax Number	:

Provider Business Practice Location Address
First Line	:	317 DEWITT ST
Second Line	:
City	:	PORTAGE
State	:	WI
Zip	:	53901-2155
Country	:	US
Telephone Number	:	608-297-9680
Fax Number	:	608-745-1757

Authorized Official
Title or Position	:
Name	:
Credential	:
Telephone Number	:

Provider Enumeration Date	:	08/24/2005
Last Update Date	:	10/16/2014

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