Provider Demographics
NPI:1003513284
Name:KISELICKA, MARIA (APNP, APRN, FNP-BC)
Entity Type:Individual
Prefix:
First Name:MARIA
Middle Name:
Last Name:KISELICKA
Suffix:
Gender:F
Credentials:APNP, APRN, FNP-BC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:9100 W OKLAHOMA AVE APT 207
Mailing Address - Street 2:
Mailing Address - City:WEST ALLIS
Mailing Address - State:WI
Mailing Address - Zip Code:53227-4812
Mailing Address - Country:US
Mailing Address - Phone:414-460-0627
Mailing Address - Fax:
Practice Address - Street 1:933 W DIVERSEY PKWY
Practice Address - Street 2:
Practice Address - City:CHICAGO
Practice Address - State:IL
Practice Address - Zip Code:60614-1439
Practice Address - Country:US
Practice Address - Phone:312-445-8805
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2023-02-08
Last Update Date:2024-02-29
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WI13555363LF0000X
IL209029140363L00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363L00000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse Practitioner
No363LF0000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerFamily