Provider Demographics
NPI:1134365075
Name:KISSNER, AIMEE (RN)
Entity type:Individual
Prefix:
First Name:AIMEE
Middle Name:
Last Name:KISSNER
Suffix:
Gender:F
Credentials:RN
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:5591 SCOTT ST
Mailing Address - Street 2:
Mailing Address - City:PITTSVILLE
Mailing Address - State:WI
Mailing Address - Zip Code:54466-9572
Mailing Address - Country:US
Mailing Address - Phone:715-884-3379
Mailing Address - Fax:
Practice Address - Street 1:5591 SCOTT ST
Practice Address - Street 2:
Practice Address - City:PITTSVILLE
Practice Address - State:WI
Practice Address - Zip Code:54466-9572
Practice Address - Country:US
Practice Address - Phone:715-884-3379
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2008-12-24
Last Update Date:2009-08-11
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WI310294-031164W00000X
WI169118-030163W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes163W00000XNursing Service ProvidersRegistered Nurse
No164W00000XNursing Service ProvidersLicensed Practical Nurse