Individual
NICHOLAS DERKOWSKI
Active
Sole proprietor
Yes
Provider details
NPI number
Gender
Man
Contact information
Practice address
2255 W PERSHING ST, APPLETON, WI 54914-6061
(920) 509-2025
Mailing address
2255 W PERSHING ST, APPLETON, WI 54914-6061
(920) 509-2025
Taxonomy
Speciality
Code
Description
License number
State
164W00000X
Licensed Practical Nurse
Primary
323307
WI
Other
Enumeration date
10/13/2018
Last updated
10/13/2018
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