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NPI Code Detail

MEDICARE: KRISTIN MARY DAHMS

MEDICARE: KRISTIN MARY DAHMS
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
1363A00000XPhysician Assistant1494WI

General Provider Information

NPI Number : 1205911831
Entity Type Code : Individual
Provider Name (Legal Business Name) : KRISTIN MARY DAHMS
Provider Business Mailing Address
First Line : 400 W GLEN ST
Second Line :
City : CRANDON
State : WI
Zip : 54520-1355
Country : US
Telephone Number :
Fax Number :
Provider Business Practice Location Address
First Line : 400 W GLEN ST
Second Line :
City : CRANDON
State : WI
Zip : 54520-1355
Country : US
Telephone Number : 715-623-9763
Fax Number :
Authorized Official
Title or Position :
Name :
Credential :
Telephone Number :
Provider Enumeration Date : 10/25/2006
Last Update Date : 10/16/2012

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Directions to “ KRISTIN MARY DAHMS ” Practice Location

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