Provider Demographics
NPI:1033502430
Name:HUCEK, KATIE MARIE (LPN)
Entity Type:Individual
Prefix:
First Name:KATIE
Middle Name:MARIE
Last Name:HUCEK
Suffix:
Gender:F
Credentials:LPN
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:N6903 COUNTY ROAD AB
Mailing Address - Street 2:
Mailing Address - City:LUXEMBURG
Mailing Address - State:WI
Mailing Address - Zip Code:54217-8209
Mailing Address - Country:US
Mailing Address - Phone:920-255-3309
Mailing Address - Fax:
Practice Address - Street 1:N6903 COUNTY ROAD AB
Practice Address - Street 2:
Practice Address - City:LUXEMBURG
Practice Address - State:WI
Practice Address - Zip Code:54217-8209
Practice Address - Country:US
Practice Address - Phone:920-255-3309
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2015-03-09
Last Update Date:2015-03-09
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WI317928164W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes164W00000XNursing Service ProvidersLicensed Practical Nurse