Provider Demographics
NPI:1730514175
Name:KATCHA, NICOLE (APNP)
Entity type:Individual
Prefix:
First Name:NICOLE
Middle Name:
Last Name:KATCHA
Suffix:
Gender:F
Credentials:APNP
Other - Prefix:
Other - First Name:NICOLE
Other - Middle Name:
Other - Last Name:WIDULE
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:RN
Mailing Address - Street 1:20611 WATERTOWN RD
Mailing Address - Street 2:SUITE J
Mailing Address - City:WAUKESHA
Mailing Address - State:WI
Mailing Address - Zip Code:53186-1871
Mailing Address - Country:US
Mailing Address - Phone:262-928-5900
Mailing Address - Fax:262-928-5925
Practice Address - Street 1:20611 WATERTOWN RD
Practice Address - Street 2:SUITE J
Practice Address - City:WAUKESHA
Practice Address - State:WI
Practice Address - Zip Code:53186-1871
Practice Address - Country:US
Practice Address - Phone:262-928-5900
Practice Address - Fax:262-928-5925
Is Sole Proprietor?:No
Enumeration Date:2013-09-04
Last Update Date:2013-09-19
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WI153059-30163WP2201X
WI5490-33363LF0000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LF0000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerFamily
No163WP2201XNursing Service ProvidersRegistered NurseAmbulatory Care