Individual
CARLY CHICANTEK
Active
Sole proprietor
No
Provider details
NPI number
Gender
F
Credential
RN
Contact information
Practice address
615 W MORELAND BLVD, WAUKESHA, WI 53188-2462
(262) 896-8465
Mailing address
615 W MORELAND BLVD, WAUKESHA, WI 53188-2462
(262) 896-8465
Taxonomy
Speciality
Code
Description
License number
State
163W00000X
Registered Nurse
Primary
168868-30
WI
Other
Enumeration date
04/23/2012
Last updated
04/23/2012
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