MEDICARE: DEBORAH MARIE KLEIMAN RN

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	163W00000X	Registered Nurse	169630-030	WI

General Provider Information

NPI Number	:	1184953135
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	DEBORAH MARIE KLEIMAN RN

Provider Business Mailing Address
First Line	:	3785 SHORE CREST TRAIL
Second Line	:
City	:	GREEN BAY
State	:	WI
Zip	:	54311
Country	:	US
Telephone Number	:	920-265-1259
Fax Number	:

Provider Business Practice Location Address
First Line	:	150 BEDFORD RD
Second Line	:
City	:	GREEN BAY
State	:	WI
Zip	:	54311-7654
Country	:	US
Telephone Number	:	920-265-1259
Fax Number	:

Authorized Official
Title or Position	:
Name	:
Credential	:
Telephone Number	:

Provider Enumeration Date	:	12/21/2009
Last Update Date	:	11/21/2022

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