Provider Demographics
NPI:1841603693
Name:LUKES, KATIE ANN (APNP)
Entity type:Individual
Prefix:
First Name:KATIE
Middle Name:ANN
Last Name:LUKES
Suffix:
Gender:F
Credentials:APNP
Other - Prefix:
Other - First Name:KATIE
Other - Middle Name:ANNE
Other - Last Name:GREGORICH
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:RN
Mailing Address - Street 1:PO BOX 22487
Mailing Address - Street 2:
Mailing Address - City:GREEN BAY
Mailing Address - State:WI
Mailing Address - Zip Code:54305-2487
Mailing Address - Country:US
Mailing Address - Phone:920-445-7210
Mailing Address - Fax:920-445-7289
Practice Address - Street 1:831 PARKER ST
Practice Address - Street 2:
Practice Address - City:ALGOMA
Practice Address - State:WI
Practice Address - Zip Code:54201-0185
Practice Address - Country:US
Practice Address - Phone:920-487-3676
Practice Address - Fax:920-487-3084
Is Sole Proprietor?:No
Enumeration Date:2014-06-10
Last Update Date:2019-09-13
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WI163224-30163W00000X
WI5932-33363LF0000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LF0000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerFamily
No163W00000XNursing Service ProvidersRegistered Nurse
Provider Identifiers
StateIdentifier IDID TypeIssuer
WIK400193904Medicare Oscar/Certification
WIK400166414Medicare Oscar/Certification