Provider Demographics
NPI:1124783006
Name:CZARNECKI, ABIGAIL (APNP)
Entity type:Individual
Prefix:
First Name:ABIGAIL
Middle Name:
Last Name:CZARNECKI
Suffix:
Gender:F
Credentials:APNP
Other - Prefix:
Other - First Name:ABIGAIL
Other - Middle Name:
Other - Last Name:KOSTRIVAS
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:APNP
Mailing Address - Street 1:10012 W CAPITOL DR
Mailing Address - Street 2:
Mailing Address - City:WAUWATOSA
Mailing Address - State:WI
Mailing Address - Zip Code:53222-1338
Mailing Address - Country:US
Mailing Address - Phone:
Mailing Address - Fax:
Practice Address - Street 1:10012 W CAPITOL DR
Practice Address - Street 2:
Practice Address - City:WAUWATOSA
Practice Address - State:WI
Practice Address - Zip Code:53222-1338
Practice Address - Country:US
Practice Address - Phone:414-810-4844
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2021-11-04
Last Update Date:2022-08-29
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WI11520-33363LP0808X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LP0808XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerPsychiatric/Mental Health