Healthcare Provider Details

I. General information

NPI: 1376729392
Provider Name (Legal Business Name): LORI MARIA KLEINHANS R.N.
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 01/21/2008
Last Update Date: 01/21/2008
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

N1579 HWY 28
ADELL WI
53001-1349
US

IV. Provider business mailing address

N1579 HWY 28
ADELL WI
53001-1349
US

V. Phone/Fax

Practice location:
  • Phone: 920-912-8519
  • Fax: 920-994-4718
Mailing address:
  • Phone: 920-912-8519
  • Fax: 920-994-4718

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code163W00000X
TaxonomyRegistered Nurse
License Number
License Number StateWI

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: