Provider Demographics
NPI:1497162317
Name:ZIEMKE, KAITLIN R (APNP)
Entity Type:Individual
Prefix:
First Name:KAITLIN
Middle Name:R
Last Name:ZIEMKE
Suffix:
Gender:F
Credentials:APNP
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:520 HARTBROOK DR STE H
Mailing Address - Street 2:
Mailing Address - City:HARTLAND
Mailing Address - State:WI
Mailing Address - Zip Code:53029-1405
Mailing Address - Country:US
Mailing Address - Phone:262-367-7900
Mailing Address - Fax:262-369-7906
Practice Address - Street 1:520 HARTBROOK DR STE H
Practice Address - Street 2:
Practice Address - City:HARTLAND
Practice Address - State:WI
Practice Address - Zip Code:53029-1405
Practice Address - Country:US
Practice Address - Phone:262-367-7900
Practice Address - Fax:262-369-7906
Is Sole Proprietor?:No
Enumeration Date:2014-07-14
Last Update Date:2022-08-30
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WI5823363L00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363L00000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse Practitioner
Provider Identifiers
StateIdentifier IDID TypeIssuer
WI1497162317Medicaid
WI1497162317Medicaid