Basic Information
| Provider Information | |||||||||
| NPI: | 1972640068 | ||||||||
| EntityType: | 1 | ||||||||
| ReplacementNPI: | |||||||||
| OrganizationName: | |||||||||
| LastName: | HAGLUND | ||||||||
| FirstName: | KRISTIN | ||||||||
| MiddleName: | ANNE | ||||||||
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| Credential: | PHD, APRN | ||||||||
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| Mailing Information | |||||||||
| Address1: | 5433 W FOND DU LAC AVE | ||||||||
| Address2: | |||||||||
| City: | MILWAUKEE | ||||||||
| State: | WI | ||||||||
| PostalCode: | 532161382 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 4142778900 | ||||||||
| FaxNumber: | 4142778939 | ||||||||
| Practice Location | |||||||||
| Address1: | 5433 W FOND DU LAC AVE | ||||||||
| Address2: | |||||||||
| City: | MILWAUKEE | ||||||||
| State: | WI | ||||||||
| PostalCode: | 532161382 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 4142778900 | ||||||||
| FaxNumber: | 4142778939 | ||||||||
| Other Information | |||||||||
| ProviderEnumerationDate: | 01/30/2007 | ||||||||
| LastUpdateDate: | 07/15/2016 | ||||||||
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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 | 363LF0000X | 573-33 | WI | N | Physician Assistants & Advanced Practice Nursing Providers | Nurse Practitioner | Family | 363LP0200X | 573-33 | WI | N | Physician Assistants & Advanced Practice Nursing Providers | Nurse Practitioner | Pediatrics | 163W00000X | 105391-030 | WI | N | Nursing Service Providers | Registered Nurse | 363L00000X | 573-33 | WI | Y | Physician Assistants & Advanced Practice Nursing Providers | Nurse Practitioner |
ID Information
| ID | Type | State | Issuer | Description | 43839100 | 05 | WI | MEDICAID |