Healthcare Provider Details

I. General information

NPI: 1013705300
Provider Name (Legal Business Name): KRISTA L URBAN RN
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 04/28/2025
Last Update Date: 04/28/2025
Certification Date: 04/28/2025
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1906 INNSBROOKE DR
SUN PRAIRIE WI
53590-3515
US

IV. Provider business mailing address

1906 INNSBROOKE DR
SUN PRAIRIE WI
53590-3515
US

V. Phone/Fax

Practice location:
  • Phone: 608-213-8892
  • Fax:
Mailing address:
  • Phone: 608-213-8892
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code163W00000X
TaxonomyRegistered Nurse
License Number179139
License Number StateWI

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: