Provider Demographics
NPI:1376502781
Name:KLUCARICH, PATRICIA LYNN (RN)
Entity Type:Individual
Prefix:MISS
First Name:PATRICIA
Middle Name:LYNN
Last Name:KLUCARICH
Suffix:
Gender:F
Credentials:RN
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:W11097 US HIGHWAY 8
Mailing Address - Street 2:
Mailing Address - City:TRIPOLI
Mailing Address - State:WI
Mailing Address - Zip Code:54564-9571
Mailing Address - Country:US
Mailing Address - Phone:715-564-7866
Mailing Address - Fax:
Practice Address - Street 1:W11097 US HIGHWAY 8
Practice Address - Street 2:
Practice Address - City:TRIPOLI
Practice Address - State:WI
Practice Address - Zip Code:54564-9571
Practice Address - Country:US
Practice Address - Phone:715-564-7866
Practice Address - Fax:
Is Sole Proprietor?:Not Answered
Enumeration Date:2006-03-23
Last Update Date:2007-07-09
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WI163W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes163W00000XNursing Service ProvidersRegistered Nurse
Provider Identifiers
StateIdentifier IDID TypeIssuer
WI38332500Medicaid