Basic Information
| Provider Information | |||||||||
| NPI: | 1811420755 | ||||||||
| EntityType: | 1 | ||||||||
| ReplacementNPI: | |||||||||
| OrganizationName: | |||||||||
| LastName: | KLUGE | ||||||||
| FirstName: | WILLIAM | ||||||||
| MiddleName: | L. | ||||||||
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| Credential: | FNP-C, CWON-AP | ||||||||
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| Mailing Information | |||||||||
| Address1: | PO BOX 43160 | ||||||||
| Address2: | |||||||||
| City: | TUCSON | ||||||||
| State: | AZ | ||||||||
| PostalCode: | 857333160 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 5207753333 | ||||||||
| FaxNumber: | 5207753334 | ||||||||
| Practice Location | |||||||||
| Address1: | 6340 N CAMPBELL AVE STE 256 | ||||||||
| Address2: | |||||||||
| City: | TUCSON | ||||||||
| State: | AZ | ||||||||
| PostalCode: | 857183186 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 5207753333 | ||||||||
| FaxNumber: | 5207753334 | ||||||||
| Other Information | |||||||||
| ProviderEnumerationDate: | 04/07/2017 | ||||||||
| LastUpdateDate: | 03/26/2020 | ||||||||
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| ProviderGenderCode: | M | ||||||||
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| IsSoleProprietor: | N | ||||||||
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| NPICertificationDate: | 03/26/2020 | ||||||||
Taxonomy Information
| Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 163WW0000X | AP10031 | AZ | N | Nursing Service Providers | Registered Nurse | Wound Care | 363LF0000X | AP10031 | AZ | Y | Physician Assistants & Advanced Practice Nursing Providers | Nurse Practitioner | Family |
ID Information
| ID | Type | State | Issuer | Description | 262803 | 05 | AZ | MEDICAID |