Provider Demographics
NPI:1275972283
Name:ULICKI, KENDRA S (ANRP)
Entity Type:Individual
Prefix:
First Name:KENDRA
Middle Name:S
Last Name:ULICKI
Suffix:
Gender:F
Credentials:ANRP
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:532 1ST ST NW
Mailing Address - Street 2:
Mailing Address - City:BRITT
Mailing Address - State:IA
Mailing Address - Zip Code:50423-1227
Mailing Address - Country:US
Mailing Address - Phone:641-843-5000
Mailing Address - Fax:641-843-5001
Practice Address - Street 1:730 W 3RD ST
Practice Address - Street 2:
Practice Address - City:GARNER
Practice Address - State:IA
Practice Address - Zip Code:50438-1242
Practice Address - Country:US
Practice Address - Phone:641-923-2651
Practice Address - Fax:641-923-2652
Is Sole Proprietor?:No
Enumeration Date:2013-06-24
Last Update Date:2013-06-24
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IA116462363L00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363L00000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse Practitioner