Healthcare Provider Details

I. General information

NPI: 1164758934
Provider Name (Legal Business Name): KATIE LYNN KAISER
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 10/28/2009
Last Update Date: 10/28/2009
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

4700 WEINKAUF RD
EDGAR WI
54426-9142
US

IV. Provider business mailing address

4700 WEINKAUF RD
EDGAR WI
54426-9142
US

V. Phone/Fax

Practice location:
  • Phone: 715-781-8219
  • Fax:
Mailing address:
  • Phone: 715-781-8219
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code163W00000X
TaxonomyRegistered Nurse
License Number162956
License Number StateWI

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: