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General NPI Number Information
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NPI Number | 1891785754
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Entity Type | Individual
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Provider Name | KIM MARIE HENRICHS N.P.
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Gender | Female
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Dates
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Enumeration Date | 10/24/2005
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Last Update Date | 04/16/2015
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Provider Practice Location Address
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Address Line | 20611 WATERTOWN RD
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City | WAUKESHA
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State | WI
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Zip | 53186-1871
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Country | US
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Telephone | 262-798-1910
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Fax | 262-798-8660
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Provider Business Mailing Address
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Address Line | S61W24405 RED WING DR
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City | WAUKESHA
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State | WI
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Zip | 53189-9511
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Country | US
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Telephone | 262-513-3154
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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 | 363LW0102X
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Taxonomy Name | Women's Health Nurse Practitioner
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License Number | 322-033
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License Number State | WI
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