Provider Demographics
NPI:1033764824
Name:MATYSIK, RENEE ALEXANDRA (RN, BSN)
Entity Type:Individual
Prefix:
First Name:RENEE
Middle Name:ALEXANDRA
Last Name:MATYSIK
Suffix:
Gender:F
Credentials:RN, BSN
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:7111 N ROCKLEDGE AVE
Mailing Address - Street 2:
Mailing Address - City:GLENDALE
Mailing Address - State:WI
Mailing Address - Zip Code:53209-2943
Mailing Address - Country:US
Mailing Address - Phone:414-550-8865
Mailing Address - Fax:
Practice Address - Street 1:7111 N ROCKLEDGE AVE
Practice Address - Street 2:
Practice Address - City:GLENDALE
Practice Address - State:WI
Practice Address - Zip Code:53209-2943
Practice Address - Country:US
Practice Address - Phone:414-550-8865
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2019-08-07
Last Update Date:2019-08-07
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WI239150163WH0200X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes163WH0200XNursing Service ProvidersRegistered NurseHome Health