Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 363LP0200X | Nurse Practitioner - Pediatrics | 4096-33 | WI |
NPI | 1043524937 |
---|---|
Provider Name | Kirsten Suzanne Koffarnus |
First Address | Madison, WI 53711-1997 |
Second Address | Madison, WI 53711-1997 |
Gender | F |
NPI Entity type | Individual |
Is Sole Proprietor | No |
Is Organization Subpart | N/A |
Enumeration Date | 03/08/2010 |
Last Update Date | 03/08/2010 |