Provider Demographics
NPI:1376892117
Name:DURSKI, AGNIESZKA (APN-FNP)
Entity Type:Individual
Prefix:
First Name:AGNIESZKA
Middle Name:
Last Name:DURSKI
Suffix:
Gender:F
Credentials:APN-FNP
Other - Prefix:
Other - First Name:AGNIESZKA
Other - Middle Name:
Other - Last Name:GADAMER
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:APN
Mailing Address - Street 1:5404 W LOOMIS RD
Mailing Address - Street 2:
Mailing Address - City:GREENDALE
Mailing Address - State:WI
Mailing Address - Zip Code:53129-1411
Mailing Address - Country:US
Mailing Address - Phone:414-329-4979
Mailing Address - Fax:
Practice Address - Street 1:5404 W LOOMIS RD
Practice Address - Street 2:
Practice Address - City:GREENDALE
Practice Address - State:WI
Practice Address - Zip Code:53129-1411
Practice Address - Country:US
Practice Address - Phone:414-329-4979
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2012-09-07
Last Update Date:2021-12-01
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IL209.009505363LF0000X
WI10948363L00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363L00000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse Practitioner
No363LF0000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerFamily
Provider Identifiers
StateIdentifier IDID TypeIssuer
WI100165826Medicaid