| Doctor Name: | JOAN M KACZINSKI |
| NPI Number: | 1255484325 |
| Entity Type Code: | Individual (1) |
| Gender: | F |
| Credentials: | NP |
| License Number: | 1999-033 |
| Business Practice Address: | 250 Wolf Run Mukwonago, WI - 531498470 |
| Business Phone Number: | 2623634751 |
| Business Fax Number: | |
| Mailing Address: | W327s8163 Memory Ln, MUKWONAGO |
| State: | WI |
| Postal Code: | 531498606 |
| Phone Number: | 2623633939 |
| Fax Number: | |
| NPI Enumeration Date: | 01/19/2007 |
| NPI Last Update Date: | 07/08/2007 |
| Replacement NPI: | 0 |
| NPI Deactivation Date: | |
| NPI Reactivation Date: |
Taxonomy Information: | |
| Healthcare Provider Taxonomy: | 363LF0000X |
| License Number: | 1999-033 |
| Healthcare Provider Taxonomy: (Secondary) | Y |
| State: | WI |
| Taxonomy Type: | Physician Assistants & Advanced Practice Nursing Providers |
| Taxonomy Classification: | Nurse Practitioner |
| Taxonomy Specialization: | Family |
| Taxonomy Definition: | |