Healthcare Provider Details

I. General information

NPI: 1962286476
Provider Name (Legal Business Name): PATRICK JOHN KLEIN APNP
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 08/24/2023
Last Update Date: 09/15/2023
Certification Date: 09/15/2023
Deactivation Date:
Reactivation Date:

III. Provider practice location address

833 S IOWA ST STE 102
DODGEVILLE WI
53533-1900
US

IV. Provider business mailing address

704 N MAIN ST
DODGEVILLE WI
53533-1134
US

V. Phone/Fax

Practice location:
  • Phone: 608-935-3301
  • Fax: 608-935-3823
Mailing address:
  • Phone: 608-412-5113
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code363L00000X
TaxonomyNurse Practitioner
License Number14354-33
License Number StateWI

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: