Basic Information
Provider Information
NPI: 1033558408
EntityType: 1
ReplacementNPI:  
OrganizationName:  
LastName: KRUEGER
FirstName: KATHRYN
MiddleName: E
NamePrefix:  
NameSuffix:  
Credential: PA
OtherOrganizationName:  
OtherOrganizationType:  
OtherLastName:  
OtherFirstName:  
OtherMiddleName:  
OtherNamePrefix:  
OtherNameSuffix:  
OtherCredential:  
OtherLastNameType:  
Mailing Information
Address1: 2801 W KINNICKINNIC RIVER PKWY
Address2: SUITE 355
City: MILWAUKEE
State: WI
PostalCode: 532153669
CountryCode: US
TelephoneNumber: 4146496430
FaxNumber: 4146495563
Practice Location
Address1: 2900 W OKLAHOMA AVE
Address2:  
City: MILWAUKEE
State: WI
PostalCode: 532154330
CountryCode: US
TelephoneNumber: 4146496430
FaxNumber: 4146495563
Other Information
ProviderEnumerationDate: 06/19/2013
LastUpdateDate: 01/23/2018
NPIDeactivationReasonCode:  
NPIDeactivationDate:  
NPIReactivationDate:  
ProviderGenderCode: F
AuthorizedOfficialLastName:  
AuthorizedOfficialFirstName:  
AuthorizedOfficialMiddleName:  
AuthorizedOfficialTitleorPosition:  
AuthorizedOfficialTelephone:  
IsSoleProprietor: N
IsOrganizationSubpart:  
ParentOrganizationLBN:  
AuthorizedOfficialNamePrefix:  
AuthorizedOfficialNameSuffix:  
AuthorizedOfficialCredential:  

Taxonomy Information
TaxonomyLicenseStateSwitchTaxonomyGroupTaxonomyTypeTaxonomyClassSubSpecialty
363A00000X WIY Physician Assistants & Advanced Practice Nursing ProvidersPhysician Assistant 

No ID Information.


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