Provider Demographics
NPI:1972028090
Name:KUCHINSKY, GENEVIEVE S (NP)
Entity Type:Individual
Prefix:MRS
First Name:GENEVIEVE
Middle Name:S
Last Name:KUCHINSKY
Suffix:
Gender:F
Credentials:NP
Other - Prefix:
Other - First Name:GENEVIEVE
Other - Middle Name:SARA
Other - Last Name:PANEK
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:
Mailing Address - Street 1:PO BOX 735044
Mailing Address - Street 2:
Mailing Address - City:CHICAGO
Mailing Address - State:IL
Mailing Address - Zip Code:60673-5044
Mailing Address - Country:US
Mailing Address - Phone:
Mailing Address - Fax:
Practice Address - Street 1:2801 W KINNICKINNIC RIVER PKWY
Practice Address - Street 2:
Practice Address - City:MILWAUKEE
Practice Address - State:WI
Practice Address - Zip Code:53215-3669
Practice Address - Country:US
Practice Address - Phone:414-385-1922
Practice Address - Fax:414-385-8781
Is Sole Proprietor?:No
Enumeration Date:2017-08-09
Last Update Date:2023-11-13
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WI7869363L00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363L00000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse Practitioner
Provider Identifiers
StateIdentifier IDID TypeIssuer
WI100070143Medicaid