Provider Demographics
NPI:1811155302
Name:CZARNECKI, MICHELLE (RN BC MSN CPNP)
Entity type:Individual
Prefix:
First Name:MICHELLE
Middle Name:
Last Name:CZARNECKI
Suffix:
Gender:F
Credentials:RN BC MSN CPNP
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:9000 W WISCONSIN AVE
Mailing Address - Street 2:MS 792
Mailing Address - City:MILWAUKEE
Mailing Address - State:WI
Mailing Address - Zip Code:53201-1997
Mailing Address - Country:US
Mailing Address - Phone:414-266-3589
Mailing Address - Fax:414-266-1761
Practice Address - Street 1:9000 W WISCONSIN AVE
Practice Address - Street 2:MS 792
Practice Address - City:MILWAUKEE
Practice Address - State:WI
Practice Address - Zip Code:53201-1997
Practice Address - Country:US
Practice Address - Phone:414-266-3589
Practice Address - Fax:414-266-1761
Is Sole Proprietor?:No
Enumeration Date:2008-05-30
Last Update Date:2021-06-18
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WI1672033363LP0200X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LP0200XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerPediatrics
Provider Identifiers
StateIdentifier IDID TypeIssuer
WI1811155302Medicaid