Provider Demographics
NPI:1548219132
Name:KIEVET, TERESA R (RN)
Entity Type:Individual
Prefix:
First Name:TERESA
Middle Name:R
Last Name:KIEVET
Suffix:
Gender:F
Credentials:RN
Other - Prefix:
Other - First Name:TERESA
Other - Middle Name:R
Other - Last Name:SCHROEDER-KIEVET
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:RN
Mailing Address - Street 1:5624 LASALLE AVE
Mailing Address - Street 2:
Mailing Address - City:STEVENS POINT
Mailing Address - State:WI
Mailing Address - Zip Code:54481-8588
Mailing Address - Country:US
Mailing Address - Phone:715-295-0990
Mailing Address - Fax:
Practice Address - Street 1:5624 LASALLE AVE
Practice Address - Street 2:
Practice Address - City:STEVENS POINT
Practice Address - State:WI
Practice Address - Zip Code:54481-8588
Practice Address - Country:US
Practice Address - Phone:715-295-0990
Practice Address - Fax:
Is Sole Proprietor?:Not Answered
Enumeration Date:2006-05-09
Last Update Date:2007-07-09
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WI114399163WH0200X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes163WH0200XNursing Service ProvidersRegistered NurseHome Health
Provider Identifiers
StateIdentifier IDID TypeIssuer
WI39951700Medicaid