# THERESA KOHLRUSCH

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- **Entity:** Individual
- **Status:** Active
- **Sole proprietor:** No

## Provider details

- **NPI number:** 1134127319
- **Gender:** F
- **Credential:** NP

## Taxonomy

| Code | Description | License number | State | Primary |
| --- | --- | --- | --- | --- |
| 363LP0200X | Pediatric Nurse Practitioner | 858 | WI | Yes |

## Other

- **Enumeration date:** 07/12/2005
- **Last updated:** 05/14/2015

## Other identifiers

| Code | Description | Identifier | Issuer | State |
| --- | --- | --- | --- | --- |
| 01 | — | 00496 | MEDICARE GROUP | WI |
| 01 | — | 1027253 | PREFERRED ONE | — |
| 05 | — | 43826100 | — | WI |
| 01 | — | 500025737 | PALMETTO GBA RR MEDICARE | — |