Provider Demographics
NPI:1669161089
Name:ROBERG, KATHLEEN ANN (RN)
Entity type:Individual
Prefix:
First Name:KATHLEEN
Middle Name:ANN
Last Name:ROBERG
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 1:917 HARBOR HOUSE DR UNIT 1
Mailing Address - Street 2:
Mailing Address - City:MADISON
Mailing Address - State:WI
Mailing Address - Zip Code:53719-3322
Mailing Address - Country:US
Mailing Address - Phone:608-370-1842
Mailing Address - Fax:
Practice Address - Street 1:2632 SMITHFIELD DR UNIT 1
Practice Address - Street 2:
Practice Address - City:FITCHBURG
Practice Address - State:WI
Practice Address - Zip Code:53719-1665
Practice Address - Country:US
Practice Address - Phone:608-370-1842
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2023-05-02
Last Update Date:2023-05-02
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WI60225-30163W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes163W00000XNursing Service ProvidersRegistered Nurse