MEDICARE: MRS. KRISTIN L KLIMISCH PNP

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	163WP0200X	Pediatric Registered Nurse	R153555	MD

General Provider Information

NPI Number	:	1770620155
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	MRS. KRISTIN L KLIMISCH PNP

Provider Business Mailing Address
First Line	:	8491 E RIDGE DR
Second Line	:
City	:	PLEASANT PRAIRIE
State	:	WI
Zip	:	53158-2039
Country	:	US
Telephone Number	:	262-764-4559
Fax Number	:

Provider Business Practice Location Address
First Line	:	8491 E RIDGE DR
Second Line	:
City	:	PLEASANT PRAIRIE
State	:	WI
Zip	:	53158-2039
Country	:	US
Telephone Number	:	262-764-4559
Fax Number	:

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

Provider Enumeration Date	:	02/01/2007
Last Update Date	:	07/08/2007

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