Provider Demographics
NPI:1639474448
Name:VALERIUS, KATHLEEN F (NP)
Entity Type:Individual
Prefix:
First Name:KATHLEEN
Middle Name:F
Last Name:VALERIUS
Suffix:
Gender:F
Credentials:NP
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Mailing Address - Street 1:721 AMERICAN AVE STE 205
Mailing Address - Street 2:PROHEALH CARE DIABETES CENTER
Mailing Address - City:WAUKESHA
Mailing Address - State:WI
Mailing Address - Zip Code:53188-5071
Mailing Address - Country:US
Mailing Address - Phone:262-928-4695
Mailing Address - Fax:262-928-5576
Practice Address - Street 1:721 AMERICAN AVE STE 205
Practice Address - Street 2:PROHEALH CARE DIABETES CENTER
Practice Address - City:WAUKESHA
Practice Address - State:WI
Practice Address - Zip Code:53188-5071
Practice Address - Country:US
Practice Address - Phone:262-928-4695
Practice Address - Fax:262-928-5576
Is Sole Proprietor?:No
Enumeration Date:2011-01-26
Last Update Date:2014-02-07
Deactivation Date:
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Provider Licenses
StateLicense IDTaxonomies
WI4332363L00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363L00000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse Practitioner
Provider Identifiers
StateIdentifier IDID TypeIssuer
WI019940531Medicare PIN
WI68375Medicare PIN
WI462364757Medicare PIN