Healthcare Provider Details

I. General information

NPI: 1932944519
Provider Name (Legal Business Name): ALLY ELIZABETH KALKOFEN APNP, FNP-BC
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 06/26/2024
Last Update Date: 09/16/2025
Certification Date: 09/16/2025
Deactivation Date:
Reactivation Date:

III. Provider practice location address

933 WAUBE LN
GREEN BAY WI
54304-5521
US

IV. Provider business mailing address

2104 MEMORIAL DR APT 212
GREEN BAY WI
54303-1294
US

V. Phone/Fax

Practice location:
  • Phone: 920-548-9500
  • Fax:
Mailing address:
  • Phone: 715-548-9158
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code363LC1500X
TaxonomyCommunity Health Nurse Practitioner
License Number1551433
License Number StateWI
# 2
Primary TaxonomyY
Taxonomy Code363LF0000X
TaxonomyFamily Nurse Practitioner
License Number15514-33
License Number StateWI

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: