Individual
DR. SHANICE S KUKUCK
Active
Sole proprietor
No
Provider details
NPI number
Gender
F
Credential
APNP
Contact information
Practice address
1700 PARADISE DR, WEST BEND, WI 53095-9795
(262) 334-3451
Mailing address
1700 W PARADISE DR, WEST BEND, WI 53095-9795
(262) 334-3451
Taxonomy
Speciality
Code
Description
License number
State
363LF0000X
Family Nurse Practitioner
11997-33
WI
363LF0000X
Family Nurse Practitioner
209032039
IL
363LP0200X
Pediatric Nurse Practitioner
Primary
209032039
IL
Other
Enumeration date
06/03/2022
Last updated
06/10/2025
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