Healthcare Provider Details

I. General information

NPI: 1801173349
Provider Name (Legal Business Name): KATHLEEN KLEEFISCH DNP, FNP-BC
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 11/11/2011
Last Update Date: 09/23/2015
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

492S BIERMA ST
WHEATFIELD IN
46392-6004
US

IV. Provider business mailing address

1104 E GRACE STREET
RENSSELAER IN
47978-3296
US

V. Phone/Fax

Practice location:
  • Phone: 219-956-2110
  • Fax: 219-956-3548
Mailing address:
  • Phone: 219-866-5141
  • Fax: 219-866-3234

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code363LF0000X
TaxonomyFamily Nurse Practitioner
License Number71003564A
License Number StateIN

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: