Provider Demographics
NPI:1811420755
Name:KLUGE, WILLIAM L (FNP-C, CWON-AP)
Entity Type:Individual
Prefix:
First Name:WILLIAM
Middle Name:L
Last Name:KLUGE
Suffix:
Gender:M
Credentials:FNP-C, CWON-AP
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:PO BOX 43160
Mailing Address - Street 2:
Mailing Address - City:TUCSON
Mailing Address - State:AZ
Mailing Address - Zip Code:85733-3160
Mailing Address - Country:US
Mailing Address - Phone:520-775-3333
Mailing Address - Fax:520-775-3334
Practice Address - Street 1:6340 N CAMPBELL AVE STE 256
Practice Address - Street 2:
Practice Address - City:TUCSON
Practice Address - State:AZ
Practice Address - Zip Code:85718-3186
Practice Address - Country:US
Practice Address - Phone:520-775-3333
Practice Address - Fax:520-775-3334
Is Sole Proprietor?:No
Enumeration Date:2017-04-07
Last Update Date:2020-03-26
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
AZAP10031163WW0000X, 363LF0000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LF0000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerFamily
No163WW0000XNursing Service ProvidersRegistered NurseWound Care
Provider Identifiers
StateIdentifier IDID TypeIssuer
AZ262803Medicaid