1932302999 NPI number — MRS. KRISTINE LYNN DAHLMAN PT

Table of content: MRS. KRISTINE LYNN DAHLMAN PT (NPI 1932302999)

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1932302999 NPI number — MRS. KRISTINE LYNN DAHLMAN PT

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
Provider Last Name:
DAHLMAN
Provider First Name:
KRISTINE
Provider Middle Name:
LYNN
Provider Name Prefix Text:
MRS.
Provider Name Suffix Text:
Provider Credential Text:
PT
Provider Gender Code:
F

Provider's Other Name Information

Provider Other Organization Name:
Provider Other Organization Name Type Code:
Provider Other Last Name:
CAMP
Provider Other First Name:
KRISTINE
Provider Other Middle Name:
LYNN
Provider Other Name Prefix Text:
MS.
Provider Other Name Suffix Text:
Provider Other Credential Text:
PT
Provider Other Last Name Type Code:
1

NPI Number Information

NPI Number:
1932302999
Entity Type Code:
Individual
Replacement NPI:
Last Update Date:
09/14/2007
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
7616 HARWOOD AVE
Provider Second Line Business Mailing Address:
APT 301
Provider Business Mailing Address City Name:
WAUWATOSA
Provider Business Mailing Address State Name:
WI
Provider Business Mailing Address Postal Code:
53213
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
414-453-1958
Provider Business Mailing Address Fax Number:

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
19525 W NORTH AVENUE
Provider Second Line Business Practice Location Address:
FRANCISCAN WOODS
Provider Business Practice Location Address City Name:
BROOKFIELD
Provider Business Practice Location Address State Name:
WI
Provider Business Practice Location Address Postal Code:
53045
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
262-780-3810
Provider Business Practice Location Address Fax Number:
262-780-3805
Provider Enumeration Date:
06/07/2007

Additional Information

Authorized Official

Authorized Official Last Name:
Authorized Official First Name:
Authorized Official Middle Name:
Authorized Official Title or Position:
Authorized Official Telephone Number:

Provider Taxonomy Codes

  • Taxonomy code: 225100000X , with the licence number:  6270024 , registered in the state of WI ; information, associated with the NPI states the following Primary Taxonomy Switch: "Y" .

Other Provider's Identifiers (legacy, non-NPI)

  • Identifier: 40319700 , issued by the state of ( WI ) . This identifiers is of the category "MEDICAID".




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