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General NPI Number Information
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NPI Number | 1245962240
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Entity Type | Individual
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Provider Name | KASONDRA KVALHEIM FNP
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Gender | Female
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Dates
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Enumeration Date | 06/28/2022
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Last Update Date | 06/28/2022
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Provider Practice Location Address
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Address Line | 16535 W BLUEMOUND RD STE 222
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City | BROOKFIELD
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State | WI
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Zip | 53005-5906
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Country | US
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Telephone | 262-754-4910
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Fax | 262-754-4913
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Provider Business Mailing Address
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Address Line | 1010 E WASHINGTON ST
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City | WEST BEND
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State | WI
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Zip | 53095-2606
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Country | US
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Telephone | 414-640-2957
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Fax |
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Authorized Official
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Title or Position |
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Name |
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Credential |
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Telephone |
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 363LF0000X
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Taxonomy Name | Family Nurse Practitioner
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License Number | 12043-33
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License Number State | WI
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