Basic Information
Provider Information | |||||||||
NPI: | 1376845776 | ||||||||
EntityType: | 1 | ||||||||
ReplacementNPI: |   | ||||||||
OrganizationName: |   | ||||||||
LastName: | KUESTER | ||||||||
FirstName: | JILL | ||||||||
MiddleName: | CHRISTINE | ||||||||
NamePrefix: | MRS. | ||||||||
NameSuffix: |   | ||||||||
Credential: | RN, MSN, CPNP-AC | ||||||||
OtherOrganizationName: |   | ||||||||
OtherOrganizationType: |   | ||||||||
OtherLastName: | JOHNSON | ||||||||
OtherFirstName: | JILL | ||||||||
OtherMiddleName: | CHRISTINE | ||||||||
OtherNamePrefix: | MS. | ||||||||
OtherNameSuffix: |   | ||||||||
OtherCredential: | RN, MSN, CPNP-AC | ||||||||
OtherLastNameType: | 1 | ||||||||
Mailing Information | |||||||||
Address1: | 9000 W WISCONSIN AVE | ||||||||
Address2: | PEDIATRIC CRITICAL CARE | ||||||||
City: | MILWAUKEE | ||||||||
State: | WI | ||||||||
PostalCode: | 532264874 | ||||||||
CountryCode: | US | ||||||||
TelephoneNumber: | 4142663360 | ||||||||
FaxNumber: | 4142663563 | ||||||||
Practice Location | |||||||||
Address1: | 9000 W WISCONSIN AVE | ||||||||
Address2: | PEDIATRIC CRITICAL CARE | ||||||||
City: | MILWAUKEE | ||||||||
State: | WI | ||||||||
PostalCode: | 532264874 | ||||||||
CountryCode: | US | ||||||||
TelephoneNumber: | 4142663360 | ||||||||
FaxNumber: | 4142663563 | ||||||||
Other Information | |||||||||
ProviderEnumerationDate: | 11/17/2010 | ||||||||
LastUpdateDate: | 04/08/2014 | ||||||||
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 | 163WN0002X | 041341067 | IL | N |   | Nursing Service Providers | Registered Nurse | Neonatal Intensive Care | 363LP0222X | 209010625 | IL | N |   | Physician Assistants & Advanced Practice Nursing Providers | Nurse Practitioner | Pediatrics, Critical Care | 363LP0222X | 4345-33 | WI | Y |   | Physician Assistants & Advanced Practice Nursing Providers | Nurse Practitioner | Pediatrics, Critical Care | 163WP0200X | 175556-30 | WI | N |   | Nursing Service Providers | Registered Nurse | Pediatrics |
No ID Information.