Healthcare Provider Details

I. General information

NPI: 1811405822
Provider Name (Legal Business Name): KATHY ANN KNETTER RN APNP FNP-BC
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 01/12/2018
Last Update Date: 03/30/2021
Certification Date: 03/30/2021
Deactivation Date:
Reactivation Date:

III. Provider practice location address

611 N SAINT JOSEPH AVE
MARSHFIELD WI
54449-1832
US

IV. Provider business mailing address

1109 ARLINGTON ST
MARSHFIELD WI
54449-3540
US

V. Phone/Fax

Practice location:
  • Phone: 715-387-7944
  • Fax:
Mailing address:
  • Phone: 715-486-6528
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code163WW0000X
TaxonomyWound Care Registered Nurse
License Number139140-30
License Number StateWI
# 2
Primary TaxonomyN
Taxonomy Code163WX1500X
TaxonomyOstomy Care Registered Nurse
License Number139140-030
License Number StateWI
# 3
Primary TaxonomyY
Taxonomy Code363LF0000X
TaxonomyFamily Nurse Practitioner
License Number6681-33
License Number StateWI

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: