Provider Demographics
NPI:1043092968
Name:VAN ASTEN, KAITLYN MARY (BSN RN)
Entity Type:Individual
Prefix:
First Name:KAITLYN
Middle Name:MARY
Last Name:VAN ASTEN
Suffix:
Gender:F
Credentials:BSN RN
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:3634 STANFORD DR
Mailing Address - Street 2:
Mailing Address - City:NEW FRANKEN
Mailing Address - State:WI
Mailing Address - Zip Code:54229-9597
Mailing Address - Country:US
Mailing Address - Phone:920-840-2897
Mailing Address - Fax:
Practice Address - Street 1:3634 STANFORD DR
Practice Address - Street 2:
Practice Address - City:NEW FRANKEN
Practice Address - State:WI
Practice Address - Zip Code:54229-9597
Practice Address - Country:US
Practice Address - Phone:920-840-2897
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2023-10-16
Last Update Date:2023-10-16
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WI223251-30163W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes163W00000XNursing Service ProvidersRegistered Nurse