Provider Demographics
NPI:1275740862
Name:ALBERT, KATHLYN ADRIAN
Entity Type:Individual
Prefix:
First Name:KATHLYN
Middle Name:ADRIAN
Last Name:ALBERT
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:KATHLYN
Other - Middle Name:ADRIAN
Other - Last Name:STANDLER
Other - Suffix:
Other - Last Name Type:Other Name
Other - Credentials:
Mailing Address - Street 1:1452 N 7TH ST
Mailing Address - Street 2:3RD FLOOR
Mailing Address - City:MILWAUKEE
Mailing Address - State:WI
Mailing Address - Zip Code:53205-2301
Mailing Address - Country:US
Mailing Address - Phone:414-933-9100
Mailing Address - Fax:414-933-9200
Practice Address - Street 1:1452 N 7TH ST
Practice Address - Street 2:3RD FLOOR
Practice Address - City:MILWAUKEE
Practice Address - State:WI
Practice Address - Zip Code:53205-2301
Practice Address - Country:US
Practice Address - Phone:414-933-9100
Practice Address - Fax:414-933-9200
Is Sole Proprietor?:No
Enumeration Date:2007-05-16
Last Update Date:2013-09-24
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WI148809-032367A00000X
WI3039-033363LF0000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LF0000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerFamily
No367A00000XPhysician Assistants & Advanced Practice Nursing ProvidersAdvanced Practice Midwife
Provider Identifiers
StateIdentifier IDID TypeIssuer
WI36044600Medicaid
WI0020280014Medicare NSC