Provider Demographics
NPI:1376729392
Name:KLEINHANS, LORI MARIA (RN)
Entity Type:Individual
Prefix:MS
First Name:LORI
Middle Name:MARIA
Last Name:KLEINHANS
Suffix:
Gender:F
Credentials:RN
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:N1579 HWY 28
Mailing Address - Street 2:
Mailing Address - City:ADELL
Mailing Address - State:WI
Mailing Address - Zip Code:53001-1349
Mailing Address - Country:US
Mailing Address - Phone:920-912-8519
Mailing Address - Fax:920-994-4718
Practice Address - Street 1:N1579 HWY 28
Practice Address - Street 2:
Practice Address - City:ADELL
Practice Address - State:WI
Practice Address - Zip Code:53001-1349
Practice Address - Country:US
Practice Address - Phone:920-912-8519
Practice Address - Fax:920-994-4718
Is Sole Proprietor?:Yes
Enumeration Date:2008-01-21
Last Update Date:2008-01-21
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WI163W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes163W00000XNursing Service ProvidersRegistered Nurse
Provider Identifiers
StateIdentifier IDID TypeIssuer
WI39925400Medicaid