Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 363L00000X | Nurse Practitioner | 9433 | WI |
N | 363LP2300X | Nurse Practitioner - Primary Care | 9433-33 | WI |
NPI | 1023667797 |
---|---|
Provider Name | Clare Tillman Kuehl |
First Address | Madison, WI 53713-2334 |
Second Address | Stoughton, WI 53589-1801 |
Gender | F |
NPI Entity type | Individual |
Is Sole Proprietor | No |
Is Organization Subpart | N/A |
Enumeration Date | 05/09/2019 |
Last Update Date | 04/12/2020 |
IDENTIFIER | TYPE / CODE | IDENTIFIER STATE |
---|---|---|
1023667797 | (05) | WI |