Provider Demographics
NPI:1508835158
Name:STREU, KIMBERLY MARIE (CFNP)
Entity Type:Individual
Prefix:MS
First Name:KIMBERLY
Middle Name:MARIE
Last Name:STREU
Suffix:
Gender:F
Credentials:CFNP
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1723 TRUMAN ST NE
Mailing Address - Street 2:
Mailing Address - City:ALBUQUERQUE
Mailing Address - State:NM
Mailing Address - Zip Code:87110-5853
Mailing Address - Country:US
Mailing Address - Phone:505-414-2150
Mailing Address - Fax:
Practice Address - Street 1:1723 TRUMAN ST NE
Practice Address - Street 2:
Practice Address - City:ALBUQUERQUE
Practice Address - State:NM
Practice Address - Zip Code:87110-5853
Practice Address - Country:US
Practice Address - Phone:505-414-2150
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2006-03-16
Last Update Date:2013-02-25
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WI1702-APNP363LF0000X
NMRN72201363LF0000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LF0000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerFamily
Provider Identifiers
StateIdentifier IDID TypeIssuer
WI170200000000OtherBLUE CROSS
WI43942600Medicaid
WI521310Medicare Oscar/Certification
WI170200000000OtherBLUE CROSS
WI0005200439Medicare ID - Type Unspecified
WI43942600Medicaid