Provider Demographics
NPI:1073200812
Name:KLUEVER, ELIZABETH
Entity Type:Individual
Prefix:
First Name:ELIZABETH
Middle Name:
Last Name:KLUEVER
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:W1343 COUNTY ROAD H
Mailing Address - Street 2:
Mailing Address - City:LOMIRA
Mailing Address - State:WI
Mailing Address - Zip Code:53048-9728
Mailing Address - Country:US
Mailing Address - Phone:262-388-9428
Mailing Address - Fax:
Practice Address - Street 1:1000 W WISCONSIN AVE STE 1
Practice Address - Street 2:
Practice Address - City:APPLETON
Practice Address - State:WI
Practice Address - Zip Code:54914-3551
Practice Address - Country:US
Practice Address - Phone:920-257-4601
Practice Address - Fax:920-257-4603
Is Sole Proprietor?:No
Enumeration Date:2023-04-21
Last Update Date:2023-04-21
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes390200000XStudent, Health CareStudent in an Organized Health Care Education/Training Program