Provider Demographics
NPI:1700178118
Name:KLEMAN, CONNIE JEANNE
Entity Type:Individual
Prefix:
First Name:CONNIE
Middle Name:JEANNE
Last Name:KLEMAN
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:5706 N VISTA LN
Mailing Address - Street 2:
Mailing Address - City:JANESVILLE
Mailing Address - State:WI
Mailing Address - Zip Code:53548-8320
Mailing Address - Country:US
Mailing Address - Phone:608-758-0176
Mailing Address - Fax:
Practice Address - Street 1:5706 N VISTA LN
Practice Address - Street 2:
Practice Address - City:JANESVILLE
Practice Address - State:WI
Practice Address - Zip Code:53548-8320
Practice Address - Country:US
Practice Address - Phone:608-758-0176
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2011-05-04
Last Update Date:2011-05-04
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WI313351031164W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes164W00000XNursing Service ProvidersLicensed Practical Nurse