Basic Information
Provider Information
NPI: 1053375774
EntityType: 1
ReplacementNPI:  
OrganizationName:  
LastName: HOENISCH
FirstName: ROBIN
MiddleName: LK
NamePrefix:  
NameSuffix:  
Credential: PAC
OtherOrganizationName:  
OtherOrganizationType:  
OtherLastName: KLOPKE
OtherFirstName: ROBIN
OtherMiddleName: L
OtherNamePrefix:  
OtherNameSuffix:  
OtherCredential: PAC
OtherLastNameType: 1
Mailing Information
Address1: 7974 UW HEALTH CT
Address2:  
City: MIDDLETON
State: WI
PostalCode: 535625531
CountryCode: US
TelephoneNumber:  
FaxNumber:  
Practice Location
Address1: 701 PARK AVE
Address2:  
City: MINNEAPOLIS
State: MN
PostalCode: 554151623
CountryCode: US
TelephoneNumber: 6128733000
FaxNumber:  
Other Information
ProviderEnumerationDate: 04/12/2006
LastUpdateDate: 03/17/2018
NPIDeactivationReasonCode:  
NPIDeactivationDate:  
NPIReactivationDate:  
ProviderGenderCode: F
AuthorizedOfficialLastName:  
AuthorizedOfficialFirstName:  
AuthorizedOfficialMiddleName:  
AuthorizedOfficialTitleorPosition:  
AuthorizedOfficialTelephone:  
IsSoleProprietor: N
IsOrganizationSubpart:  
ParentOrganizationLBN:  
AuthorizedOfficialNamePrefix:  
AuthorizedOfficialNameSuffix:  
AuthorizedOfficialCredential:  
NPICertificationDate:  

Taxonomy Information
TaxonomyLicenseStateSwitchTaxonomyGroupTaxonomyTypeTaxonomyClassSubSpecialty
363A00000X1429-23WIY Physician Assistants & Advanced Practice Nursing ProvidersPhysician Assistant 

No ID Information.


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