Healthcare Provider Details

I. General information

NPI: 1720279177
Provider Name (Legal Business Name): DENISE LYNN KLEMM RN,RCS
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 08/08/2007
Last Update Date: 08/08/2007
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

S4782 POTTER RD
BARABOO WI
53913-9612
US

IV. Provider business mailing address

S4782 POTTER RD
BARABOO WI
53913-9612
US

V. Phone/Fax

Practice location:
  • Phone: 608-356-7826
  • Fax:
Mailing address:
  • Phone: 608-356-7826
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code163WH0200X
TaxonomyHome Health Registered Nurse
License Number71946-030
License Number StateWI

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: