Provider Demographics
NPI:1588006944
Name:KLEINHANS, ALICE F (PA-C)
Entity Type:Individual
Prefix:
First Name:ALICE
Middle Name:F
Last Name:KLEINHANS
Suffix:
Gender:F
Credentials:PA-C
Other - Prefix:
Other - First Name:ALICE
Other - Middle Name:L
Other - Last Name:FEHLANDT
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:PA-C
Mailing Address - Street 1:1000 N OAK AVE
Mailing Address - Street 2:
Mailing Address - City:MARSHFIELD
Mailing Address - State:WI
Mailing Address - Zip Code:54449-5703
Mailing Address - Country:US
Mailing Address - Phone:715-387-5511
Mailing Address - Fax:
Practice Address - Street 1:2260 N SHORE DR
Practice Address - Street 2:
Practice Address - City:RHINELANDER
Practice Address - State:WI
Practice Address - Zip Code:54501-8888
Practice Address - Country:US
Practice Address - Phone:715-420-2379
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2013-07-25
Last Update Date:2022-07-28
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IL085.004764363A00000X
WI5811-23363A00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363A00000XPhysician Assistants & Advanced Practice Nursing ProvidersPhysician Assistant
Provider Identifiers
StateIdentifier IDID TypeIssuer
WI1588006944Medicaid
WI1588006944Medicaid