Provider Demographics
NPI:1750540803
Name:CANTIERI, KATHLEEN S (FNP)
Entity type:Individual
Prefix:MRS
First Name:KATHLEEN
Middle Name:S
Last Name:CANTIERI
Suffix:
Gender:F
Credentials:FNP
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:13500 WRAYBURN RD
Mailing Address - Street 2:
Mailing Address - City:ELM GROVE
Mailing Address - State:WI
Mailing Address - Zip Code:53122-1350
Mailing Address - Country:US
Mailing Address - Phone:262-786-9350
Mailing Address - Fax:
Practice Address - Street 1:611 W NATIONAL AVE
Practice Address - Street 2:SUITE 400
Practice Address - City:MILWAUKEE
Practice Address - State:WI
Practice Address - Zip Code:53204-1714
Practice Address - Country:US
Practice Address - Phone:414-384-1400
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2008-06-04
Last Update Date:2008-06-04
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WI78890-030363LF0000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LF0000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerFamily