Provider Demographics
NPI:1306221619
Name:KROLL, KAREN M (FNP)
Entity Type:Individual
Prefix:
First Name:KAREN
Middle Name:M
Last Name:KROLL
Suffix:
Gender:F
Credentials:FNP
Other - Prefix:
Other - First Name:KAREN
Other - Middle Name:M
Other - Last Name:KOENIG
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:FNP
Mailing Address - Street 1:PO BOX 22487
Mailing Address - Street 2:
Mailing Address - City:GREEN BAY
Mailing Address - State:WI
Mailing Address - Zip Code:54305-2487
Mailing Address - Country:US
Mailing Address - Phone:920-445-7210
Mailing Address - Fax:920-445-7289
Practice Address - Street 1:1630 COMMANCHE AVE STE 102
Practice Address - Street 2:
Practice Address - City:GREEN BAY
Practice Address - State:WI
Practice Address - Zip Code:54313-5753
Practice Address - Country:US
Practice Address - Phone:920-433-6000
Practice Address - Fax:920-430-4719
Is Sole Proprietor?:No
Enumeration Date:2015-07-28
Last Update Date:2023-07-14
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WI6536363LF0000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LF0000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerFamily
Provider Identifiers
StateIdentifier IDID TypeIssuer
2015003628OtherAMERICAN NURSES CREDENTIALING CENTER