Provider Demographics
NPI:1689854853
Name:KIEFFER, NICOLE ANNA (DO)
Entity type:Individual
Prefix:DR
First Name:NICOLE
Middle Name:ANNA
Last Name:KIEFFER
Suffix:
Gender:F
Credentials:DO
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:2223 LIME KILN RD STE 1
Mailing Address - Street 2:
Mailing Address - City:GREEN BAY
Mailing Address - State:WI
Mailing Address - Zip Code:54311-6238
Mailing Address - Country:US
Mailing Address - Phone:920-430-8113
Mailing Address - Fax:
Practice Address - Street 1:2223 LIME KILN RD STE 1
Practice Address - Street 2:
Practice Address - City:GREEN BAY
Practice Address - State:WI
Practice Address - Zip Code:54311-6238
Practice Address - Country:US
Practice Address - Phone:920-430-8113
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2007-11-05
Last Update Date:2025-05-28
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WAOP60447300207R00000X, 207RR0500X, 207RR0500X
WI53103207RR0500X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207RR0500XAllopathic & Osteopathic PhysiciansInternal MedicineRheumatology
No207R00000XAllopathic & Osteopathic PhysiciansInternal Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
WI100003672Medicaid
WA1689854853Medicaid