Provider Demographics
NPI:1972925170
Name:DOEMEL, KRISTINE M (APNP)
Entity Type:Individual
Prefix:
First Name:KRISTINE
Middle Name:M
Last Name:DOEMEL
Suffix:
Gender:F
Credentials:APNP
Other - Prefix:
Other - First Name:KRISTINE
Other - Middle Name:M
Other - Last Name:BOWMAN
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:APNP
Mailing Address - Street 1:2509 COUNTY HIGHWAY I
Mailing Address - Street 2:
Mailing Address - City:CHIPPEWA FALLS
Mailing Address - State:WI
Mailing Address - Zip Code:54729-2785
Mailing Address - Country:US
Mailing Address - Phone:715-717-4944
Mailing Address - Fax:
Practice Address - Street 1:2509 COUNTY HIGHWAY I
Practice Address - Street 2:
Practice Address - City:CHIPPEWA FALLS
Practice Address - State:WI
Practice Address - Zip Code:54729
Practice Address - Country:US
Practice Address - Phone:715-717-4944
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2014-01-08
Last Update Date:2018-07-13
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WI5639363L00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363L00000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse Practitioner
Provider Identifiers
StateIdentifier IDID TypeIssuer
WI5639OtherAPNP LIC
WI131207OtherRN LICENSE