Healthcare Provider Details

I. General information

NPI: 1992340137
Provider Name (Legal Business Name): GINA KIEFER RN
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 11/12/2019
Last Update Date: 04/09/2026
Certification Date: 04/09/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

4000 STATE ROAD 16 - VALLEY VIEW MALL ANNEX
LA CROSSE WI
54601
US

IV. Provider business mailing address

2525 WESTERN AVE
LA CROSSE WI
54603-1149
US

V. Phone/Fax

Practice location:
  • Phone: 608-784-3886
  • Fax: 608-374-8201
Mailing address:
  • Phone: 608-784-3886
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code163WP2201X
TaxonomyAmbulatory Care Registered Nurse
License Number191204-30
License Number StateWI

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: