Provider Demographics
NPI:1255484325
Name:KACZINSKI, JOAN M (NP)
Entity Type:Individual
Prefix:
First Name:JOAN
Middle Name:M
Last Name:KACZINSKI
Suffix:
Gender:F
Credentials:NP
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
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Other - Credentials:
Mailing Address - Street 1:2500 W LAYTON AVE
Mailing Address - Street 2:SUITE 30
Mailing Address - City:MILWAUKEE
Mailing Address - State:WI
Mailing Address - Zip Code:53221-5420
Mailing Address - Country:US
Mailing Address - Phone:414-269-5336
Mailing Address - Fax:414-269-5437
Practice Address - Street 1:2500 W LAYTON AVE
Practice Address - Street 2:SUITE 30
Practice Address - City:MILWAUKEE
Practice Address - State:WI
Practice Address - Zip Code:53221-5420
Practice Address - Country:US
Practice Address - Phone:414-269-5336
Practice Address - Fax:414-269-5437
Is Sole Proprietor?:No
Enumeration Date:2007-01-19
Last Update Date:2016-08-30
Deactivation Date:
Deactivation Code:
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Provider Licenses
StateLicense IDTaxonomies
WI1999-033363LF0000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LF0000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerFamily
Provider Identifiers
StateIdentifier IDID TypeIssuer
WIP72075Medicare UPIN