Basic Information
Provider Information
NPI: 1396774212
EntityType: 1
ReplacementNPI:  
OrganizationName:  
LastName: KRESS
FirstName: PATRICIA
MiddleName: L
NamePrefix:  
NameSuffix:  
Credential: MD
OtherOrganizationName:  
OtherOrganizationType:  
OtherLastName:  
OtherFirstName:  
OtherMiddleName:  
OtherNamePrefix:  
OtherNameSuffix:  
OtherCredential:  
OtherLastNameType:  
Mailing Information
Address1: 7974 UW HEALTH CT
Address2:  
City: MIDDLETON
State: WI
PostalCode: 535625531
CountryCode: US
TelephoneNumber:  
FaxNumber:  
Practice Location
Address1: 617 W CLAIREMONT AVE
Address2:  
City: EAU CLAIRE
State: WI
PostalCode: 547016223
CountryCode: US
TelephoneNumber: 7158395175
FaxNumber: 7158395176
Other Information
ProviderEnumerationDate: 07/02/2006
LastUpdateDate: 03/03/2009
NPIDeactivationReasonCode:  
NPIDeactivationDate:  
NPIReactivationDate:  
ProviderGenderCode: F
AuthorizedOfficialLastName:  
AuthorizedOfficialFirstName:  
AuthorizedOfficialMiddleName:  
AuthorizedOfficialTitleorPosition:  
AuthorizedOfficialTelephone:  
IsSoleProprietor: N
IsOrganizationSubpart:  
ParentOrganizationLBN:  
AuthorizedOfficialNamePrefix:  
AuthorizedOfficialNameSuffix:  
AuthorizedOfficialCredential:  
NPICertificationDate:  

Taxonomy Information
TaxonomyLicenseStateSwitchTaxonomyGroupTaxonomyTypeTaxonomyClassSubSpecialty
207Q00000X28775WIY Allopathic & Osteopathic PhysiciansFamily Medicine 

No ID Information.


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