Healthcare Provider Details

I. General information

NPI: 1285957373
Provider Name (Legal Business Name): KIM ANN GREIVELDINGER BSN, RNC
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 03/03/2010
Last Update Date: 03/03/2010
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

N48W16443 LONE OAK LN
MENOMONEE FALLS WI
53051-6641
US

IV. Provider business mailing address

N48W16443 LONE OAK LN
MENOMONEE FALLS WI
53051-6641
US

V. Phone/Fax

Practice location:
  • Phone: 262-352-8178
  • Fax:
Mailing address:
  • Phone: 262-352-8178
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code163WH0200X
TaxonomyHome Health Registered Nurse
License Number87782-30
License Number StateWI
# 2
Primary TaxonomyN
Taxonomy Code163WX0002X
TaxonomyHigh-Risk Obstetric Registered Nurse
License Number87782-30
License Number StateWI

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: