MEDICARE: KRISTIN JOAN BORTMANN R.N.

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	196698-30	WI

General Provider Information

NPI Number	:	1942641907
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	KRISTIN JOAN BORTMANN R.N.

Provider Business Mailing Address
First Line	:	5021 S JONATHAN LN
Second Line	:
City	:	NEW BERLIN
State	:	WI
Zip	:	53151-7620
Country	:	US
Telephone Number	:	414-550-1897
Fax Number	:

Provider Business Practice Location Address
First Line	:	5021 S JONATHAN LN
Second Line	:
City	:	NEW BERLIN
State	:	WI
Zip	:	53151-7620
Country	:	US
Telephone Number	:	414-550-1897
Fax Number	:

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

Provider Enumeration Date	:	07/07/2013
Last Update Date	:	07/07/2013

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