Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 207RR0500X | Rheumatology | 30435-020 | WI |
NPI | 1033152061 |
---|---|
Provider Name | Joanne M Kriege |
First Address | Baraboo, WI 53913-1501 |
Second Address | Baraboo, WI 53913-1501 |
Gender | F |
NPI Entity type | Individual |
Is Sole Proprietor | No |
Is Organization Subpart | N/A |
Enumeration Date | 14/06/2006 |
Last Update Date | 03/11/2021 |
IDENTIFIER | TYPE / CODE | IDENTIFIER STATE |
---|---|---|
1033152061 | (05) | WI |
F72565 | (02) |