Provider Demographics
NPI:1598195372
Name:KLEIN, THERESA A (APNP)
Entity Type:Individual
Prefix:
First Name:THERESA
Middle Name:A
Last Name:KLEIN
Suffix:
Gender:F
Credentials:APNP
Other - Prefix:
Other - First Name:THERESA
Other - Middle Name:A
Other - Last Name:EHR
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:APNP
Mailing Address - Street 1:475 W RIVER WOODS PKWY
Mailing Address - Street 2:
Mailing Address - City:GLENDALE
Mailing Address - State:WI
Mailing Address - Zip Code:53212-1081
Mailing Address - Country:US
Mailing Address - Phone:414-961-6767
Mailing Address - Fax:414-961-6727
Practice Address - Street 1:475 W RIVER WOODS PKWY
Practice Address - Street 2:
Practice Address - City:GLENDALE
Practice Address - State:WI
Practice Address - Zip Code:53212-1081
Practice Address - Country:US
Practice Address - Phone:414-961-6767
Practice Address - Fax:414-961-6727
Is Sole Proprietor?:No
Enumeration Date:2013-11-15
Last Update Date:2016-11-21
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WI5599363L00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363L00000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse Practitioner