Provider Demographics
NPI:1003259649
Name:PISCHKE, KRYSTINA MARIE
Entity Type:Individual
Prefix:
First Name:KRYSTINA
Middle Name:MARIE
Last Name:PISCHKE
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:PO BOX 8003
Mailing Address - Street 2:
Mailing Address - City:APPLETON
Mailing Address - State:WI
Mailing Address - Zip Code:54912-8003
Mailing Address - Country:US
Mailing Address - Phone:920-830-5900
Mailing Address - Fax:920-738-5787
Practice Address - Street 1:1504 S COMMERCIAL ST
Practice Address - Street 2:
Practice Address - City:NEENAH
Practice Address - State:WI
Practice Address - Zip Code:54956-4802
Practice Address - Country:US
Practice Address - Phone:920-729-6088
Practice Address - Fax:920-729-6484
Is Sole Proprietor?:No
Enumeration Date:2013-04-13
Last Update Date:2016-09-28
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WI63282207Q00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207Q00000XAllopathic & Osteopathic PhysiciansFamily Medicine