Provider Demographics
NPI:1720279177
Name:KLEMM, DENISE LYNN (RN,RCS)
Entity Type:Individual
Prefix:
First Name:DENISE
Middle Name:LYNN
Last Name:KLEMM
Suffix:
Gender:F
Credentials:RN,RCS
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:S4782 POTTER RD
Mailing Address - Street 2:
Mailing Address - City:BARABOO
Mailing Address - State:WI
Mailing Address - Zip Code:53913-9612
Mailing Address - Country:US
Mailing Address - Phone:608-356-7826
Mailing Address - Fax:
Practice Address - Street 1:S4782 POTTER RD
Practice Address - Street 2:
Practice Address - City:BARABOO
Practice Address - State:WI
Practice Address - Zip Code:53913-9612
Practice Address - Country:US
Practice Address - Phone:608-356-7826
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2007-08-08
Last Update Date:2007-08-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WI71946-030163WH0200X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes163WH0200XNursing Service ProvidersRegistered NurseHome Health
Provider Identifiers
StateIdentifier IDID TypeIssuer
WI35003400Medicaid