Provider Demographics
NPI:1689977399
Name:KRUEGER, KATHRYN M (CPNP)
Entity Type:Individual
Prefix:
First Name:KATHRYN
Middle Name:M
Last Name:KRUEGER
Suffix:
Gender:F
Credentials:CPNP
Other - Prefix:
Other - First Name:KATHRYN
Other - Middle Name:M
Other - Last Name:KRAMER
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:
Mailing Address - Street 1:9000 W WISCONSIN AVE
Mailing Address - Street 2:DIVISION OF PEDIATRIC CARDIOLOGY
Mailing Address - City:MILWAUKEE
Mailing Address - State:WI
Mailing Address - Zip Code:53226-4874
Mailing Address - Country:US
Mailing Address - Phone:414-266-6457
Mailing Address - Fax:414-266-2294
Practice Address - Street 1:9000 W WISCONSIN AVE
Practice Address - Street 2:DIVISION OF PEDIATRIC CARDIOLOGY
Practice Address - City:MILWAUKEE
Practice Address - State:WI
Practice Address - Zip Code:53226-4874
Practice Address - Country:US
Practice Address - Phone:414-266-6457
Practice Address - Fax:414-266-2294
Is Sole Proprietor?:No
Enumeration Date:2010-12-20
Last Update Date:2011-08-11
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WI155276363LP0200X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LP0200XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerPediatrics
Provider Identifiers
StateIdentifier IDID TypeIssuer
WI1689977399Medicaid
WI1689977399Medicaid