Healthcare Provider Details

I. General information

NPI: 1871562058
Provider Name (Legal Business Name): KRISTEN MARJORIE DALL-WINTHER MD, FAAFP
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

Provider Other Name: KRISTEN MARJORIE GREEN LERBERG MD

II. Dates (important events)

Enumeration Date: 03/17/2006
Last Update Date: 06/26/2024
Certification Date: 06/26/2024
Deactivation Date:
Reactivation Date:

III. Provider practice location address

101 WEST LOOMIS STREET SUITE A
BIRCHWOOD WI
54817
US

IV. Provider business mailing address

PO BOX 2
BIRCHWOOD WI
54817-0002
US

V. Phone/Fax

Practice location:
  • Phone: 715-202-6782
  • Fax: 715-800-1972
Mailing address:
  • Phone: 715-202-6782
  • Fax: 715-800-1972

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code207Q00000X
TaxonomyFamily Medicine Physician
License Number48468-020
License Number StateWI

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: