Healthcare Provider Details

I. General information

NPI: 1285866376
Provider Name (Legal Business Name): RONALD J KRINN
Entity Type: Individual
Gender: Male
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 08/22/2009
Last Update Date: 08/22/2009
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1103 S 4TH ST
MILWAUKEE WI
53204-2444
US

IV. Provider business mailing address

1103 S 4TH ST
MILWAUKEE WI
53204-2444
US

V. Phone/Fax

Practice location:
  • Phone: 414-364-4706
  • Fax:
Mailing address:
  • Phone: 414-364-4706
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code163WC0200X
TaxonomyCritical Care Medicine Registered Nurse
License Number149637-30
License Number StateWI
# 2
Primary TaxonomyN
Taxonomy Code163WG0000X
TaxonomyGeneral Practice Registered Nurse
License Number149637-30
License Number StateWI

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: