Provider Demographics
NPI:1841298858
Name:KRESSE, MARIE EMMA (PA-C)
Entity type:Individual
Prefix:
First Name:MARIE
Middle Name:EMMA
Last Name:KRESSE
Suffix:
Gender:F
Credentials:PA-C
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:801 YORK ST
Mailing Address - Street 2:
Mailing Address - City:MANITOWOC
Mailing Address - State:WI
Mailing Address - Zip Code:54220-4630
Mailing Address - Country:US
Mailing Address - Phone:920-663-9034
Mailing Address - Fax:920-663-0370
Practice Address - Street 1:12327 STRATFORD DR
Practice Address - Street 2:
Practice Address - City:CLIVE
Practice Address - State:IA
Practice Address - Zip Code:50325-8148
Practice Address - Country:US
Practice Address - Phone:515-224-7088
Practice Address - Fax:515-224-9228
Is Sole Proprietor?:No
Enumeration Date:2005-07-13
Last Update Date:2021-02-22
Deactivation Date:2006-03-31
Deactivation Code:
Reactivation Date:2006-03-31
Provider Licenses
StateLicense IDTaxonomies
IA000707363A00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363A00000XPhysician Assistants & Advanced Practice Nursing ProvidersPhysician Assistant
Provider Identifiers
StateIdentifier IDID TypeIssuer
IA45587Medicare ID - Type Unspecified
IAS57196Medicare UPIN