Provider Demographics
NPI:1699196170
Name:BAUSCH, KRISTIN ANNE (LPN)
Entity Type:Individual
Prefix:MRS
First Name:KRISTIN
Middle Name:ANNE
Last Name:BAUSCH
Suffix:
Gender:F
Credentials:LPN
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:331 N MONROE ST
Mailing Address - Street 2:
Mailing Address - City:LANCASTER
Mailing Address - State:WI
Mailing Address - Zip Code:53813-1339
Mailing Address - Country:US
Mailing Address - Phone:608-485-1726
Mailing Address - Fax:
Practice Address - Street 1:331 N MONROE ST
Practice Address - Street 2:
Practice Address - City:LANCASTER
Practice Address - State:WI
Practice Address - Zip Code:53813-1339
Practice Address - Country:US
Practice Address - Phone:608-485-1726
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2013-12-30
Last Update Date:2013-12-30
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WI317106-31164W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes164W00000XNursing Service ProvidersLicensed Practical Nurse