Basic Information
Provider Information | |||||||||
NPI: | 1376045856 | ||||||||
EntityType: | 1 | ||||||||
ReplacementNPI: |   | ||||||||
OrganizationName: |   | ||||||||
LastName: | ZIEMBA | ||||||||
FirstName: | KARI | ||||||||
MiddleName: | B | ||||||||
NamePrefix: |   | ||||||||
NameSuffix: |   | ||||||||
Credential: | NP | ||||||||
OtherOrganizationName: |   | ||||||||
OtherOrganizationType: |   | ||||||||
OtherLastName: | ANDRE | ||||||||
OtherFirstName: | KARI | ||||||||
OtherMiddleName: | B. | ||||||||
OtherNamePrefix: |   | ||||||||
OtherNameSuffix: |   | ||||||||
OtherCredential: | NP | ||||||||
OtherLastNameType: | 1 | ||||||||
Mailing Information | |||||||||
Address1: | BELOIT HEALTH SYSTEM INC. | ||||||||
Address2: | BELOIT CLINIC 1905 E. HUEBBE PARKWAY | ||||||||
City: | BELOIT | ||||||||
State: | WI | ||||||||
PostalCode: | 53511 | ||||||||
CountryCode: | US | ||||||||
TelephoneNumber: | 6083642220 | ||||||||
FaxNumber: |   | ||||||||
Practice Location | |||||||||
Address1: | BELOIT HEALTH SYSTEM INC. | ||||||||
Address2: | BELOIT CLINIC 1905 E. HUEBBE PARKWAY | ||||||||
City: | BELOIT | ||||||||
State: | WI | ||||||||
PostalCode: | 53511 | ||||||||
CountryCode: | US | ||||||||
TelephoneNumber: | 6083642220 | ||||||||
FaxNumber: |   | ||||||||
Other Information | |||||||||
ProviderEnumerationDate: | 03/01/2018 | ||||||||
LastUpdateDate: | 03/01/2018 | ||||||||
NPIDeactivationReasonCode: |   | ||||||||
NPIDeactivationDate: |   | ||||||||
NPIReactivationDate: |   | ||||||||
ProviderGenderCode: | F | ||||||||
AuthorizedOfficialLastName: |   | ||||||||
AuthorizedOfficialFirstName: |   | ||||||||
AuthorizedOfficialMiddleName: |   | ||||||||
AuthorizedOfficialTitleorPosition: |   | ||||||||
AuthorizedOfficialTelephone: |   | ||||||||
IsSoleProprietor: | N | ||||||||
IsOrganizationSubpart: |   | ||||||||
ParentOrganizationLBN: |   | ||||||||
AuthorizedOfficialNamePrefix: |   | ||||||||
AuthorizedOfficialNameSuffix: |   | ||||||||
AuthorizedOfficialCredential: |   | ||||||||
NPICertificationDate: |   |
Taxonomy Information
Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 363L00000X | 8258-33 | WI | Y |   | Physician Assistants & Advanced Practice Nursing Providers | Nurse Practitioner |   |
No ID Information.