MEDICARE: KAITLIN S. EARLEY C.N.M.

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	363LX0001X	Obstetrics & Gynecology Nurse Practitioner	148894	WI
2	367A00000X	Advanced Practice Midwife	148894	WI

General Provider Information

NPI Number	:	1225295736
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	KAITLIN S. EARLEY C.N.M.

Provider Business Mailing Address
First Line	:	200 1ST ST SW
Second Line	:
City	:	ROCHESTER
State	:	MN
Zip	:	55905-0001
Country	:	US
Telephone Number	:	608-785-0940
Fax Number	:

Provider Business Practice Location Address
First Line	:	895 DETTLOFF DR
Second Line	:
City	:	ARCADIA
State	:	WI
Zip	:	54612-2600
Country	:	US
Telephone Number	:	608-785-0940
Fax Number	:

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

Provider Enumeration Date	:	05/21/2008
Last Update Date	:	11/08/2023

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