Kim T Duczak, APNP
Individual provider Active NPI Nurse Practitioner · Waterford, WI
NPI 1346355542 · NPPES record last updated Dec 1, 2021
Key facts
- NPI
- 1346355542
- Entity type
- Individual (NPI type 1)
- Primary specialty
- Nurse Practitioner 363L00000X
- License
- 1544-033 (WI)
- Practice address
- 818 Forrest LN
Waterford, WI 53185 - Phone
- (262) 514-3700
- Fax
- (262) 514-3865
- NPI assigned
- Aug 20, 2006
- Sex
- Female
- Sole proprietor
- No
Organizations & group practices 1
Medicare participation
- Medicare fee-for-service enrollment
- Not listed in the public Medicare enrollment file
National Provider Directory
- Medicare enrollment (NPD)
- Yes
- Credentials
- Nurse Practitioner
State licenses
| License | State | Type | Specialty |
|---|---|---|---|
| 1544-033 | WI | MD | Nurse Practitioner |
| 80028-030 | WI | MD | Nurse Practitioner |
Practice roles
| Organization | Specialty | Status | New patients |
|---|---|---|---|
| Aurora Medical Group, Inc. | Past | Accepting new patients |
Specialties & licenses
| Specialty (taxonomy) | Code | License | State | Primary |
|---|---|---|---|---|
| Nurse Practitioner | 363L00000X | 1544-033 | WI | Yes |
| Nurse Practitioner | 363L00000X | 80028-030 | WI |
Addresses
Primary practice location
818 Forrest LN
Waterford, WI 53185
Mailing address
3301 W Forest Home Ave
Milwaukee, WI 53215-2843
Phone (262) 514-3700
Other identifiers
| Identifier | Type | State | Issuer |
|---|---|---|---|
| 4393500 | Medicaid | WI |
Other names
- Kim Tracy Nauta
Electronic endpoints
| Type | Endpoint | Use | Affiliation |
|---|---|---|---|
| Direct Messaging Address | kduczak45167@direct.myadvocateaurora.org | Direct | |
| FHIR URL | https://EpicFHIR.aurora.org/FHIR/MYAURORA/api/FHIR/DSTU2/ |
Other providers in Waterford, WI
- Lenore Marie Desouto-Thren
- Pavneet Kaur Dhillon
- Christine M Dignan
- Erin Emily Droy
- Cathy Jo Duchow-Cross
- Kelli Dunham
- Lynette Marie Edwards
- Lynn Ellen Erickson-Meier
- Eye Wisconsin LLC
- Matthew Ferlindes
All providers in Waterford, WI · Nurse Practitioner in Wisconsin
Sources for this page
- NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Record last updated by the provider on Dec 1, 2021. Information in NPPES is self-reported and not verified by CMS.
- NUCC Health Care Provider Taxonomy: specialty names.
- National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.