Provider Demographics
NPI:1952384638
Name:WIELICHOWSKI, LUANNE M (APRN BC)
Entity type:Individual
Prefix:MS
First Name:LUANNE
Middle Name:M
Last Name:WIELICHOWSKI
Suffix:
Gender:F
Credentials:APRN BC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
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Mailing Address - Street 1:2985 S CHICAGO AVE
Mailing Address - Street 2:
Mailing Address - City:SOUTH MILWAUKEE
Mailing Address - State:WI
Mailing Address - Zip Code:53172-3133
Mailing Address - Country:US
Mailing Address - Phone:414-762-7322
Mailing Address - Fax:414-246-3810
Practice Address - Street 1:2985 S CHICAGO AVE
Practice Address - Street 2:
Practice Address - City:SOUTH MILWAUKEE
Practice Address - State:WI
Practice Address - Zip Code:53172-3133
Practice Address - Country:US
Practice Address - Phone:414-762-7322
Practice Address - Fax:414-246-3810
Is Sole Proprietor?:Yes
Enumeration Date:2005-11-27
Last Update Date:2021-11-23
Deactivation Date:
Deactivation Code:
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Provider Licenses
StateLicense IDTaxonomies
WI2142363L00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363L00000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse Practitioner