Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 363LF0000X | Nurse Practitioner - Family Medicine | 4229-33 | WI |
NPI | 1003124819 |
---|---|
Provider Name | Kristin L. Rubenzer |
First Address | Green Bay, WI 54307-9070 |
Second Address | Menomonie, WI 54751-1578 |
Gender | F |
NPI Entity type | Individual |
Is Sole Proprietor | No |
Is Organization Subpart | N/A |
Enumeration Date | 15/09/2010 |
Last Update Date | 17/03/2017 |