Healthcare Provider Details

I. General information

NPI: 1386952182
Provider Name (Legal Business Name): KRISTIN M. PENDL L.AC.
Entity Type: Individual
Gender: Female
Sole Proprietor: N

Provider Other Name: KRISTIN M. CONNOR L.AC.

II. Dates (important events)

Enumeration Date: 09/15/2010
Last Update Date: 07/02/2013
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

6041 MONONA DR SUITE 101
MONONA WI
53716-3964
US

IV. Provider business mailing address

6041 MONONA DR SUITE 101
MONONA WI
53716-3964
US

V. Phone/Fax

Practice location:
  • Phone: 608-222-0250
  • Fax:
Mailing address:
  • Phone: 608-222-0250
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code171100000X
TaxonomyAcupuncturist
License Number621-055
License Number StateWI

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: