Basic Information
| Provider Information | |||||||||
| NPI: | 1669066650 | ||||||||
| EntityType: | 1 | ||||||||
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| OrganizationName: | |||||||||
| LastName: | GAY | ||||||||
| FirstName: | KRISTINE | ||||||||
| MiddleName: | MARIE | ||||||||
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| Credential: | APNP | ||||||||
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| Mailing Information | |||||||||
| Address1: | N2600 N KOHN RD | ||||||||
| Address2: | |||||||||
| City: | REESEVILLE | ||||||||
| State: | WI | ||||||||
| PostalCode: | 535799740 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 9202109886 | ||||||||
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| Practice Location | |||||||||
| Address1: | 4260 E TOWNE BLVD | ||||||||
| Address2: | |||||||||
| City: | MADISON | ||||||||
| State: | WI | ||||||||
| PostalCode: | 537043704 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 6082441213 | ||||||||
| FaxNumber: | 6082445508 | ||||||||
| Other Information | |||||||||
| ProviderEnumerationDate: | 02/22/2021 | ||||||||
| LastUpdateDate: | 03/08/2022 | ||||||||
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| ProviderGenderCode: | F | ||||||||
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| IsSoleProprietor: | N | ||||||||
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| NPICertificationDate: | 03/08/2022 | ||||||||
Taxonomy Information
| Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 363LF0000X | 10513-33 | WI | Y | Physician Assistants & Advanced Practice Nursing Providers | Nurse Practitioner | Family |
No ID Information.