Provider Demographics
NPI:1003364811
Name:MICHEL, KAITLIN M (FNP-BC)
Entity Type:Individual
Prefix:
First Name:KAITLIN
Middle Name:M
Last Name:MICHEL
Suffix:
Gender:F
Credentials:FNP-BC
Other - Prefix:
Other - First Name:KAITLIN
Other - Middle Name:M
Other - Last Name:SCHAEREN
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:FNP-BC
Mailing Address - Street 1:5433 W FOND DU LAC AVE
Mailing Address - Street 2:
Mailing Address - City:MILWAUKEE
Mailing Address - State:WI
Mailing Address - Zip Code:53216-1382
Mailing Address - Country:US
Mailing Address - Phone:414-277-8909
Mailing Address - Fax:414-277-8939
Practice Address - Street 1:5433 W FOND DU LAC AVE
Practice Address - Street 2:
Practice Address - City:MILWAUKEE
Practice Address - State:WI
Practice Address - Zip Code:53216-1382
Practice Address - Country:US
Practice Address - Phone:414-277-8909
Practice Address - Fax:414-277-8939
Is Sole Proprietor?:No
Enumeration Date:2016-09-21
Last Update Date:2022-12-15
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WI196487-30363LF0000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LF0000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerFamily
Provider Identifiers
StateIdentifier IDID TypeIssuer
WI1003364811Medicaid