Provider Demographics
NPI:1891785754
Name:HENRICHS, KIM MARIE (NP)
Entity Type:Individual
Prefix:MS
First Name:KIM
Middle Name:MARIE
Last Name:HENRICHS
Suffix:
Gender:F
Credentials:NP
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:S61W24405 RED WING DR
Mailing Address - Street 2:
Mailing Address - City:WAUKESHA
Mailing Address - State:WI
Mailing Address - Zip Code:53189-9511
Mailing Address - Country:US
Mailing Address - Phone:262-513-3154
Mailing Address - Fax:
Practice Address - Street 1:20611 WATERTOWN RD
Practice Address - Street 2:
Practice Address - City:WAUKESHA
Practice Address - State:WI
Practice Address - Zip Code:53186-1871
Practice Address - Country:US
Practice Address - Phone:262-798-1910
Practice Address - Fax:262-798-8660
Is Sole Proprietor?:No
Enumeration Date:2005-10-24
Last Update Date:2015-04-16
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WI322-033363LW0102X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LW0102XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerWomen's Health