Provider Demographics
NPI:1770620155
Name:KLIMISCH, KRISTIN L (PNP)
Entity type:Individual
Prefix:MRS
First Name:KRISTIN
Middle Name:L
Last Name:KLIMISCH
Suffix:
Gender:F
Credentials:PNP
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:8491 E RIDGE DR
Mailing Address - Street 2:
Mailing Address - City:PLEASANT PRAIRIE
Mailing Address - State:WI
Mailing Address - Zip Code:53158-2039
Mailing Address - Country:US
Mailing Address - Phone:262-764-4559
Mailing Address - Fax:
Practice Address - Street 1:8491 E RIDGE DR
Practice Address - Street 2:
Practice Address - City:PLEASANT PRAIRIE
Practice Address - State:WI
Practice Address - Zip Code:53158-2039
Practice Address - Country:US
Practice Address - Phone:262-764-4559
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2007-02-01
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MDR153555163WP0200X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes163WP0200XNursing Service ProvidersRegistered NursePediatrics