Provider Demographics
NPI:1073155073
Name:KREKLING, AMANDA
Entity Type:Individual
Prefix:MRS
First Name:AMANDA
Middle Name:
Last Name:KREKLING
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:2704 JAMES BLVD
Mailing Address - Street 2:
Mailing Address - City:RACINE
Mailing Address - State:WI
Mailing Address - Zip Code:53403-3248
Mailing Address - Country:US
Mailing Address - Phone:262-497-2098
Mailing Address - Fax:
Practice Address - Street 1:6580 S 46TH ST
Practice Address - Street 2:
Practice Address - City:FRANKLIN
Practice Address - State:WI
Practice Address - Zip Code:53132-8153
Practice Address - Country:US
Practice Address - Phone:414-421-0276
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2019-10-10
Last Update Date:2019-10-10
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WI189534163W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes163W00000XNursing Service ProvidersRegistered Nurse