Healthcare Provider Details

I. General information

NPI: 1942060686
Provider Name (Legal Business Name): KAYLA HOTZ FNP-C
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 03/20/2024
Last Update Date: 04/05/2024
Certification Date: 04/05/2024
Deactivation Date:
Reactivation Date:

III. Provider practice location address

4802 E BROADWAY
MADISON WI
53716-4141
US

IV. Provider business mailing address

38 S MAIN ST
OCONOMOWOC WI
53066-7200
US

V. Phone/Fax

Practice location:
  • Phone: 608-889-7500
  • Fax:
Mailing address:
  • Phone:
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code163W00000X
TaxonomyRegistered Nurse
License Number246279-30
License Number StateWI
# 2
Primary TaxonomyY
Taxonomy Code363LP2300X
TaxonomyPrimary Care Nurse Practitioner
License Number15198-33
License Number StateWI

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: