Provider Demographics
NPI:1235414665
Name:SCHWERDTFEGER, KIMBERLY A (NP)
Entity Type:Individual
Prefix:
First Name:KIMBERLY
Middle Name:A
Last Name:SCHWERDTFEGER
Suffix:
Gender:F
Credentials:NP
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:PO BOX 81548
Mailing Address - Street 2:
Mailing Address - City:RACINE
Mailing Address - State:WI
Mailing Address - Zip Code:53408-1548
Mailing Address - Country:US
Mailing Address - Phone:262-898-4400
Mailing Address - Fax:262-898-4423
Practice Address - Street 1:6233 BANKERS RD
Practice Address - Street 2:SUITE 3
Practice Address - City:MOUNT PLEASANT
Practice Address - State:WI
Practice Address - Zip Code:53403-9700
Practice Address - Country:US
Practice Address - Phone:262-898-4400
Practice Address - Fax:262-898-4423
Is Sole Proprietor?:No
Enumeration Date:2011-10-17
Last Update Date:2012-10-02
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WI4627363L00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363L00000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse Practitioner
Provider Identifiers
StateIdentifier IDID TypeIssuer
WI4627OtherLICENSE