Basic Information
| Provider Information | |||||||||
| NPI: | 1568870566 | ||||||||
| EntityType: | 1 | ||||||||
| ReplacementNPI: | |||||||||
| OrganizationName: | |||||||||
| LastName: | KLEITSCH | ||||||||
| FirstName: | SPENCER | ||||||||
| MiddleName: | KAY | ||||||||
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| Credential: | ARNP | ||||||||
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| Mailing Information | |||||||||
| Address1: | PO BOX 148 | ||||||||
| Address2: | |||||||||
| City: | SUMNER | ||||||||
| State: | IA | ||||||||
| PostalCode: | 506740148 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 5635783275 | ||||||||
| FaxNumber: | 5635783279 | ||||||||
| Practice Location | |||||||||
| Address1: | 1753 W RIDGEWAY AVE STE 111 | ||||||||
| Address2: | |||||||||
| City: | WATERLOO | ||||||||
| State: | IA | ||||||||
| PostalCode: | 507014588 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 3198335970 | ||||||||
| FaxNumber: | 3198335971 | ||||||||
| Other Information | |||||||||
| ProviderEnumerationDate: | 07/23/2014 | ||||||||
| LastUpdateDate: | 02/25/2019 | ||||||||
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| ProviderGenderCode: | F | ||||||||
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| IsSoleProprietor: | N | ||||||||
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Taxonomy Information
| Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 363L00000X | A130599 | IA | Y | Physician Assistants & Advanced Practice Nursing Providers | Nurse Practitioner |
No ID Information.