Provider Demographics
NPI:1275878977
Name:WUNDERLIN, KAYLA M (LPN)
Entity Type:Individual
Prefix:
First Name:KAYLA
Middle Name:M
Last Name:WUNDERLIN
Suffix:
Gender:F
Credentials:LPN
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:710 VILLAGE GREEN LN E
Mailing Address - Street 2:
Mailing Address - City:MADISON
Mailing Address - State:WI
Mailing Address - Zip Code:53704-3285
Mailing Address - Country:US
Mailing Address - Phone:608-770-2140
Mailing Address - Fax:
Practice Address - Street 1:5752 TOKAY BLV
Practice Address - Street 2:STE 500
Practice Address - City:MADISON
Practice Address - State:WI
Practice Address - Zip Code:53719-6000
Practice Address - Country:US
Practice Address - Phone:608-232-1000
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2012-12-06
Last Update Date:2012-12-06
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WI313177-31164W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes164W00000XNursing Service ProvidersLicensed Practical Nurse