Provider Demographics
NPI:1659944940
Name:SAROSIEK, KELLY (DNP, APNP, FNP-BC)
Entity type:Individual
Prefix:MS
First Name:KELLY
Middle Name:
Last Name:SAROSIEK
Suffix:
Gender:F
Credentials:DNP, APNP, FNP-BC
Other - Prefix:
Other - First Name:KELLY
Other - Middle Name:
Other - Last Name:SZCZEPANSKI
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:
Mailing Address - Street 1:2794 SUMMERSET CIR
Mailing Address - Street 2:
Mailing Address - City:SUAMICO
Mailing Address - State:WI
Mailing Address - Zip Code:54173-8013
Mailing Address - Country:US
Mailing Address - Phone:920-461-2771
Mailing Address - Fax:
Practice Address - Street 1:2794 SUMMERSET CIR
Practice Address - Street 2:
Practice Address - City:SUAMICO
Practice Address - State:WI
Practice Address - Zip Code:54173-8013
Practice Address - Country:US
Practice Address - Phone:920-461-2771
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2021-07-23
Last Update Date:2024-07-29
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WI11102-33363LF0000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LF0000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerFamily