Provider Demographics
NPI:1992355085
Name:SALESKE, NICOLE (FNP-BC, APNP)
Entity type:Individual
Prefix:
First Name:NICOLE
Middle Name:
Last Name:SALESKE
Suffix:
Gender:F
Credentials:FNP-BC, APNP
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:890 JOEANNA WAY
Mailing Address - Street 2:
Mailing Address - City:PULASKI
Mailing Address - State:WI
Mailing Address - Zip Code:54162-9206
Mailing Address - Country:US
Mailing Address - Phone:920-252-3523
Mailing Address - Fax:
Practice Address - Street 1:2638 TULIP LN STE B
Practice Address - Street 2:
Practice Address - City:GREEN BAY
Practice Address - State:WI
Practice Address - Zip Code:54313-2801
Practice Address - Country:US
Practice Address - Phone:920-429-2844
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2019-09-19
Last Update Date:2019-09-19
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WI9624-33363L00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363L00000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse Practitioner