Provider Demographics
NPI:1972520625
Name:DEDRICK, JOYCE M (APNP)
Entity type:Individual
Prefix:
First Name:JOYCE
Middle Name:M
Last Name:DEDRICK
Suffix:
Gender:F
Credentials:APNP
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:650 MCMILLEN ST
Mailing Address - Street 2:
Mailing Address - City:FORT ATKINSON
Mailing Address - State:WI
Mailing Address - Zip Code:53538-1275
Mailing Address - Country:US
Mailing Address - Phone:920-563-8900
Mailing Address - Fax:920-563-0318
Practice Address - Street 1:650 MCMILLEN ST
Practice Address - Street 2:
Practice Address - City:FORT ATKINSON
Practice Address - State:WI
Practice Address - Zip Code:53538-1275
Practice Address - Country:US
Practice Address - Phone:920-563-8900
Practice Address - Fax:920-563-0318
Is Sole Proprietor?:No
Enumeration Date:2006-07-17
Last Update Date:2023-03-07
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WI93496-030163W00000X
WI186-033363LW0102X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LW0102XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerWomen's Health
No163W00000XNursing Service ProvidersRegistered Nurse
Provider Identifiers
StateIdentifier IDID TypeIssuer
WI43836600Medicaid
WIMD0366042OtherDEA
WI43836600Medicaid
S58024Medicare UPIN