Provider Demographics
NPI:1841403888
Name:CADDOCK, KRISTI E (NP)
Entity Type:Individual
Prefix:MRS
First Name:KRISTI
Middle Name:E
Last Name:CADDOCK
Suffix:
Gender:F
Credentials:NP
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Mailing Address - Street 1:3200 PLEASANT VALLEY RD
Mailing Address - Street 2:KRAEMER CANCER CARE CENTER
Mailing Address - City:WEST BEND
Mailing Address - State:WI
Mailing Address - Zip Code:53095-9274
Mailing Address - Country:US
Mailing Address - Phone:262-836-7200
Mailing Address - Fax:262-836-7201
Practice Address - Street 1:3200 PLEASANT VALLEY RD
Practice Address - Street 2:KRAEMER CANCER CARE CENTER
Practice Address - City:WEST BEND
Practice Address - State:WI
Practice Address - Zip Code:53095-9274
Practice Address - Country:US
Practice Address - Phone:262-836-7200
Practice Address - Fax:262-836-7201
Is Sole Proprietor?:No
Enumeration Date:2007-05-07
Last Update Date:2013-02-14
Deactivation Date:
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Provider Licenses
StateLicense IDTaxonomies
WI3091363L00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363L00000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse Practitioner
Provider Identifiers
StateIdentifier IDID TypeIssuer
WI1841403888Medicaid
WI1841403888Medicaid