Provider Demographics
NPI:1902497514
Name:FOSS-PEPERKORN, KRISTINE (REGISTERED NURSE)
Entity Type:Individual
Prefix:
First Name:KRISTINE
Middle Name:
Last Name:FOSS-PEPERKORN
Suffix:
Gender:M
Credentials:REGISTERED NURSE
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:8383 GREENWAY BLVD STE 600
Mailing Address - Street 2:
Mailing Address - City:MIDDLETON
Mailing Address - State:WI
Mailing Address - Zip Code:53562-4659
Mailing Address - Country:US
Mailing Address - Phone:608-213-4977
Mailing Address - Fax:
Practice Address - Street 1:8383 GREENWAY BLVD STE 600
Practice Address - Street 2:
Practice Address - City:MIDDLETON
Practice Address - State:WI
Practice Address - Zip Code:53562-4659
Practice Address - Country:US
Practice Address - Phone:608-213-4977
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2021-01-27
Last Update Date:2021-01-27
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WI130532163WC0400X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes163WC0400XNursing Service ProvidersRegistered NurseCase Management