Provider Demographics
NPI:1518209949
Name:KRIMMER, NICOLE ELIZABETH (MD)
Entity Type:Individual
Prefix:
First Name:NICOLE
Middle Name:ELIZABETH
Last Name:KRIMMER
Suffix:
Gender:F
Credentials:MD
Other - Prefix:
Other - First Name:NICOLE
Other - Middle Name:ELIZABETH
Other - Last Name:PURCELL
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:
Mailing Address - Street 1:8651 W NORTH AVE
Mailing Address - Street 2:
Mailing Address - City:WAUWATOSA
Mailing Address - State:WI
Mailing Address - Zip Code:53226-2721
Mailing Address - Country:US
Mailing Address - Phone:414-774-9200
Mailing Address - Fax:414-774-9031
Practice Address - Street 1:8651 W NORTH AVE
Practice Address - Street 2:
Practice Address - City:WAUWATOSA
Practice Address - State:WI
Practice Address - Zip Code:53226-2721
Practice Address - Country:US
Practice Address - Phone:414-774-9200
Practice Address - Fax:414-774-9031
Is Sole Proprietor?:No
Enumeration Date:2013-03-24
Last Update Date:2016-07-06
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WI63047-20208000000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes208000000XAllopathic & Osteopathic PhysiciansPediatrics
Provider Identifiers
StateIdentifier IDID TypeIssuer
WI1518209949Medicaid