Provider Demographics
NPI:1255839338
Name:KIENAST, KRYSTINA L (FNP-BC)
Entity Type:Individual
Prefix:
First Name:KRYSTINA
Middle Name:L
Last Name:KIENAST
Suffix:
Gender:F
Credentials:FNP-BC
Other - Prefix:
Other - First Name:KRYSTINA
Other - Middle Name:L
Other - Last Name:KOEPP
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:RN
Mailing Address - Street 1:343 EVERGREEN LN
Mailing Address - Street 2:
Mailing Address - City:PEWAUKEE
Mailing Address - State:WI
Mailing Address - Zip Code:53072-2403
Mailing Address - Country:US
Mailing Address - Phone:262-719-0519
Mailing Address - Fax:
Practice Address - Street 1:1155 N MAYFAIR RD
Practice Address - Street 2:
Practice Address - City:WAUWATOSA
Practice Address - State:WI
Practice Address - Zip Code:53226-3462
Practice Address - Country:US
Practice Address - Phone:414-955-5990
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2018-01-24
Last Update Date:2018-01-24
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WI2017032701363LF0000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LF0000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerFamily