Provider Demographics
NPI:1790929891
Name:KROENING, JODY ERICA (RN/DNP PMHNP-BC)
Entity Type:Individual
Prefix:DR
First Name:JODY
Middle Name:ERICA
Last Name:KROENING
Suffix:
Gender:F
Credentials:RN/DNP PMHNP-BC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
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Other - Credentials:
Mailing Address - Street 1:23062 WHITEHALL RD
Mailing Address - Street 2:
Mailing Address - City:INDEPENDENCE
Mailing Address - State:WI
Mailing Address - Zip Code:54747-9065
Mailing Address - Country:US
Mailing Address - Phone:715-985-3452
Mailing Address - Fax:715-598-6093
Practice Address - Street 1:23062 WHITEHALL RD
Practice Address - Street 2:
Practice Address - City:INDEPENDENCE
Practice Address - State:WI
Practice Address - Zip Code:54747-9065
Practice Address - Country:US
Practice Address - Phone:715-985-3452
Practice Address - Fax:715-598-6093
Is Sole Proprietor?:Yes
Enumeration Date:2009-04-21
Last Update Date:2016-06-25
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MNCNP 4563363LP0808X
MNR-188871-3163W00000X
WI166522163W00000X
WI7026-33363LP0808X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LP0808XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerPsychiatric/Mental Health
No163W00000XNursing Service ProvidersRegistered Nurse