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General NPI Number Information
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NPI Number | 1821360967
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Entity Type | Individual
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Provider Name | KRISTINE MARIE VAN ESS OTR
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Gender | Female
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Dates
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Enumeration Date | 02/06/2012
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Last Update Date | 02/28/2014
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Provider Practice Location Address
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Address Line | 7135 ROCKY KNOLL PKWY
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City | PLYMOUTH
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State | WI
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Zip | 53073
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Country | US
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Telephone | 920-893-6441
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Fax |
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Provider Business Mailing Address
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Address Line | N6162 HILLSIDE RD
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City | PLYMOUTH
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State | WI
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Zip | 53073-4326
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Country | US
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Telephone | 920-893-9727
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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 | 171M00000X
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Taxonomy Name | Case Manager/Care Coordinator
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License Number | 1427-26
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License Number State | WI
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