Provider Demographics
NPI:1497430680
Name:KLEINER, COLE JOSEPH CARPENTER (STUDENT)
Entity Type:Individual
Prefix:
First Name:COLE
Middle Name:JOSEPH CARPENTER
Last Name:KLEINER
Suffix:
Gender:M
Credentials:STUDENT
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:565 PARK ST
Mailing Address - Street 2:
Mailing Address - City:DICKEYVILLE
Mailing Address - State:WI
Mailing Address - Zip Code:53808-6853
Mailing Address - Country:US
Mailing Address - Phone:563-513-9392
Mailing Address - Fax:
Practice Address - Street 1:565 PARK ST
Practice Address - Street 2:
Practice Address - City:DICKEYVILLE
Practice Address - State:WI
Practice Address - Zip Code:53808-6853
Practice Address - Country:US
Practice Address - Phone:563-513-9392
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2023-06-16
Last Update Date:2023-06-16
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes390200000XStudent, Health CareStudent in an Organized Health Care Education/Training Program