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General NPI Number Information
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NPI Number | 1427323286
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Entity Type | Individual
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Provider Name | KIRSTEN JOY HENDRICKSON VAN ASTEN M.S.
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Gender | Female
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Dates
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Enumeration Date | 03/13/2012
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Last Update Date | 03/13/2012
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Provider Practice Location Address
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Address Line | 1506 S ONEIDA ST
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City | APPLETON
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State | WI
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Zip | 54915-1305
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Country | US
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Telephone | 920-738-2558
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Fax |
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Provider Business Mailing Address
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Address Line | 922 DENISE CT
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City | KAUKAUNA
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State | WI
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Zip | 54130-1110
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Country | US
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Telephone | 608-558-6459
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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 | 224Y00000X
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Taxonomy Name | Clinical Exercise Physiologist
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License Number |
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License Number State |
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