Provider Demographics
NPI:1851808059
Name:KACZMAREK, ALLISON DANIELLE (APNP)
Entity Type:Individual
Prefix:
First Name:ALLISON
Middle Name:DANIELLE
Last Name:KACZMAREK
Suffix:
Gender:F
Credentials:APNP
Other - Prefix:
Other - First Name:ALLISON
Other - Middle Name:DANIELLE
Other - Last Name:BERG
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:
Mailing Address - Street 1:2761 N WEIL ST
Mailing Address - Street 2:
Mailing Address - City:MILWAUKEE
Mailing Address - State:WI
Mailing Address - Zip Code:53212-2617
Mailing Address - Country:US
Mailing Address - Phone:310-266-0398
Mailing Address - Fax:
Practice Address - Street 1:1700 W PARADISE DR
Practice Address - Street 2:
Practice Address - City:WEST BEND
Practice Address - State:WI
Practice Address - Zip Code:53095-9795
Practice Address - Country:US
Practice Address - Phone:262-334-3451
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2018-01-09
Last Update Date:2018-01-09
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WI8204-33363L00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363L00000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse Practitioner