Provider Demographics
NPI:1376928457
Name:KLESMITH, NADINE
Entity Type:Individual
Prefix:
First Name:NADINE
Middle Name:
Last Name:KLESMITH
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 1:1210 ASHWOOD DRIVE
Mailing Address - Street 2:
Mailing Address - City:PLOVER
Mailing Address - State:WI
Mailing Address - Zip Code:54467
Mailing Address - Country:US
Mailing Address - Phone:715-343-2996
Mailing Address - Fax:
Practice Address - Street 1:420 DEWEY STREET
Practice Address - Street 2:CARLSON GI CLINIC
Practice Address - City:WISCONSIN RAPIDS
Practice Address - State:WI
Practice Address - Zip Code:54494
Practice Address - Country:US
Practice Address - Phone:715-421-1001
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2015-07-30
Last Update Date:2015-07-30
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WI6223363LF0000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LF0000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerFamily