Provider Demographics
NPI:1346130317
Name:CLEMMER, KRISTIN KATHLEEN
Entity type:Individual
Prefix:
First Name:KRISTIN
Middle Name:KATHLEEN
Last Name:CLEMMER
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:12110 E COUNTY ROAD FF
Mailing Address - Street 2:
Mailing Address - City:MAPLE
Mailing Address - State:WI
Mailing Address - Zip Code:54854-9345
Mailing Address - Country:US
Mailing Address - Phone:715-558-6404
Mailing Address - Fax:
Practice Address - Street 1:12110 E COUNTY ROAD FF
Practice Address - Street 2:
Practice Address - City:MAPLE
Practice Address - State:WI
Practice Address - Zip Code:54854-9345
Practice Address - Country:US
Practice Address - Phone:715-558-6404
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2025-07-09
Last Update Date:2025-07-24
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WI168687-30163WH0200X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes163WH0200XNursing Service ProvidersRegistered NurseHome Health