Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 363LC1500X | Nurse Practitioner - Community Health | 1518 | WI |
NPI | 1053339796 |
---|---|
Provider Name | Janet E. Kieslich |
First Address | Racine, WI 53405-1600 |
Second Address | Racine, WI 53405-1600 |
Gender | F |
NPI Entity type | Individual |
Is Sole Proprietor | No |
Is Organization Subpart | N/A |
Enumeration Date | 18/07/2006 |
Last Update Date | 08/07/2007 |
IDENTIFIER | TYPE / CODE | IDENTIFIER STATE |
---|---|---|
P14313 | (02) |