Provider Demographics
NPI:1861513962
Name:KRAHN, JODY ANN (DNP, RN, WHNP-BC)
Entity type:Individual
Prefix:
First Name:JODY
Middle Name:ANN
Last Name:KRAHN
Suffix:
Gender:F
Credentials:DNP, RN, WHNP-BC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:313 SHERIDAN DR
Mailing Address - Street 2:
Mailing Address - City:WEST BEND
Mailing Address - State:WI
Mailing Address - Zip Code:53095-4266
Mailing Address - Country:US
Mailing Address - Phone:262-306-8762
Mailing Address - Fax:
Practice Address - Street 1:5380 W FOND DU LAC AVE
Practice Address - Street 2:
Practice Address - City:MILWAUKEE
Practice Address - State:WI
Practice Address - Zip Code:53216-1366
Practice Address - Country:US
Practice Address - Phone:414-536-6690
Practice Address - Fax:414-536-6830
Is Sole Proprietor?:No
Enumeration Date:2007-04-03
Last Update Date:2013-05-28
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WI131619-030363L00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363L00000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse Practitioner