Healthcare Provider Details

I. General information

NPI: 1376845776
Provider Name (Legal Business Name): JILL CHRISTINE KUESTER RN, MSN, CPNP-AC
Entity Type: Individual
Gender: Female
Sole Proprietor: N

Provider Other Name: JILL CHRISTINE JOHNSON RN, MSN, CPNP-AC

II. Dates (important events)

Enumeration Date: 11/17/2010
Last Update Date: 04/08/2014
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

9000 W WISCONSIN AVE PEDIATRIC CRITICAL CARE
MILWAUKEE WI
53226-4874
US

IV. Provider business mailing address

9000 W WISCONSIN AVE PEDIATRIC CRITICAL CARE
MILWAUKEE WI
53226-4874
US

V. Phone/Fax

Practice location:
  • Phone: 414-266-3360
  • Fax: 414-266-3563
Mailing address:
  • Phone: 414-266-3360
  • Fax: 414-266-3563

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code163WN0002X
TaxonomyNeonatal Intensive Care Registered Nurse
License Number041341067
License Number StateIL
# 2
Primary TaxonomyN
Taxonomy Code363LP0222X
TaxonomyCritical Care Pediatric Nurse Practitioner
License Number209010625
License Number StateIL
# 3
Primary TaxonomyY
Taxonomy Code363LP0222X
TaxonomyCritical Care Pediatric Nurse Practitioner
License Number4345-33
License Number StateWI
# 4
Primary TaxonomyN
Taxonomy Code163WP0200X
TaxonomyPediatric Registered Nurse
License Number175556-30
License Number StateWI

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: