Provider Demographics
NPI:1043524937
Name:KOFFARNUS, KIRSTEN SUZANNE (RN, MS, CPNP, APNP)
Entity Type:Individual
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First Name:KIRSTEN
Middle Name:SUZANNE
Last Name:KOFFARNUS
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Gender:F
Credentials:RN, MS, CPNP, APNP
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Mailing Address - Street 1:1000 EDGEWOOD COLLEGE DR
Mailing Address - Street 2:EDGEWOOD COLLEGE HEALTH CENTER
Mailing Address - City:MADISON
Mailing Address - State:WI
Mailing Address - Zip Code:53711-1997
Mailing Address - Country:US
Mailing Address - Phone:608-663-8334
Mailing Address - Fax:608-663-3394
Practice Address - Street 1:1000 EDGEWOOD COLLEGE DR
Practice Address - Street 2:EDGEWOOD COLLEGE HEALTH CENTER
Practice Address - City:MADISON
Practice Address - State:WI
Practice Address - Zip Code:53711-1997
Practice Address - Country:US
Practice Address - Phone:608-663-8334
Practice Address - Fax:608-663-3394
Is Sole Proprietor?:No
Enumeration Date:2010-08-03
Last Update Date:2010-08-03
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Deactivation Code:
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Provider Licenses
StateLicense IDTaxonomies
WI4096-33363LP0200X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LP0200XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerPediatrics