Provider Demographics
NPI:1386935161
Name:KACZMARSKI, EMMY LOU (APNP)
Entity type:Individual
Prefix:MRS
First Name:EMMY
Middle Name:LOU
Last Name:KACZMARSKI
Suffix:
Gender:F
Credentials:APNP
Other - Prefix:
Other - First Name:EMMY
Other - Middle Name:LOU
Other - Last Name:GABOWER
Other - Suffix:
Other - Last Name Type:Professional Name
Other - Credentials:RN
Mailing Address - Street 1:1100 BERGSLIEN ST
Mailing Address - Street 2:
Mailing Address - City:BALDWIN
Mailing Address - State:WI
Mailing Address - Zip Code:54002-2600
Mailing Address - Country:US
Mailing Address - Phone:715-684-1111
Mailing Address - Fax:715-684-1119
Practice Address - Street 1:1100 BERGSLIEN ST
Practice Address - Street 2:
Practice Address - City:BALDWIN
Practice Address - State:WI
Practice Address - Zip Code:54002-2600
Practice Address - Country:US
Practice Address - Phone:715-684-1111
Practice Address - Fax:715-684-1119
Is Sole Proprietor?:No
Enumeration Date:2011-04-27
Last Update Date:2019-11-20
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WI141148-30163W00000X
WI9752363LF0000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LF0000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerFamily
No163W00000XNursing Service ProvidersRegistered Nurse