Healthcare Provider Details

I. General information

NPI: 1679406102
Provider Name (Legal Business Name): EMILY L KLOACK
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 06/04/2026
Last Update Date: 06/04/2026
Certification Date: 06/04/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

3870 NAKOMA RD
MADISON WI
53711-3096
US

IV. Provider business mailing address

5507 QUARRY HILL DR
FITCHBURG WI
53711-4916
US

V. Phone/Fax

Practice location:
  • Phone: 604-204-6941
  • Fax:
Mailing address:
  • Phone: 608-204-6941
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code163WS0200X
TaxonomySchool Registered Nurse
License Number263714-30
License Number StateWI

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: