Healthcare Provider Details

I. General information

NPI: 1497465488
Provider Name (Legal Business Name): KRISTIE ESCH
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 11/30/2022
Last Update Date: 11/30/2022
Certification Date: 11/25/2022
Deactivation Date:
Reactivation Date:

III. Provider practice location address

2500 OVERLOOK TER
MADISON WI
53705-2254
US

IV. Provider business mailing address

5344 NOBEL DRIVE UNIT 3
FITCHBURG WI
53711
US

V. Phone/Fax

Practice location:
  • Phone: 608-256-1901
  • Fax:
Mailing address:
  • Phone: 608-438-2095
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code163W00000X
TaxonomyRegistered Nurse
License Number159362-30
License Number StateWI

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: