Basic Information
| Provider Information | |||||||||
| NPI: | 1427524735 | ||||||||
| EntityType: | 1 | ||||||||
| ReplacementNPI: | |||||||||
| OrganizationName: | |||||||||
| LastName: | KRAHENBUHL | ||||||||
| FirstName: | NICOLE | ||||||||
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| Credential: | RN | ||||||||
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| Mailing Information | |||||||||
| Address1: | 400 S TOWNLINE RD | ||||||||
| Address2: | |||||||||
| City: | WAUTOMA | ||||||||
| State: | WI | ||||||||
| PostalCode: | 549826922 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 9207875514 | ||||||||
| FaxNumber: | 9207879343 | ||||||||
| Practice Location | |||||||||
| Address1: | 880 HERRIOT DR | ||||||||
| Address2: | |||||||||
| City: | MAUSTON | ||||||||
| State: | WI | ||||||||
| PostalCode: | 539482031 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 6088476700 | ||||||||
| FaxNumber: | 6088476122 | ||||||||
| Other Information | |||||||||
| ProviderEnumerationDate: | 10/15/2018 | ||||||||
| LastUpdateDate: | 06/15/2020 | ||||||||
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| ProviderGenderCode: | F | ||||||||
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| IsSoleProprietor: | N | ||||||||
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| NPICertificationDate: | 06/15/2020 | ||||||||
Taxonomy Information
| Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 163WM0705X | 222403-30 | WI | N | Nursing Service Providers | Registered Nurse | Medical-Surgical | 124Q00000X | 590916 | WI | Y | Dental Providers | Dental Hygienist |
No ID Information.