Healthcare Provider Details

I. General information

NPI: 1558080903
Provider Name (Legal Business Name): KATHRYN BEECROFT APNP
Entity Type: Individual
Gender: Female
Sole Proprietor: N

Provider Other Name: KATHRYN GARIBALDI

II. Dates (important events)

Enumeration Date: 08/26/2022
Last Update Date: 06/04/2024
Certification Date: 06/04/2024
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1705 16TH AVE
CUMBERLAND WI
54829-8601
US

IV. Provider business mailing address

1705 16TH AVE
CUMBERLAND WI
54829-8601
US

V. Phone/Fax

Practice location:
  • Phone: 715-822-7500
  • Fax: 715-822-7221
Mailing address:
  • Phone: 715-822-7500
  • Fax: 715-822-7221

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code363LF0000X
TaxonomyFamily Nurse Practitioner
License Number12143
License Number StateWI

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: