Individual
KRISTINE S TAIVALMAA
Active
Sole proprietor
No
Provider details
NPI number
Gender
F
Credential
MD
Contact information
Practice address
420 E DIVISION ST, FOND DU LAC, WI 54935-4560
(920) 926-8424
(920) 926-8389
Mailing address
420 E DIVISION ST, FOND DU LAC, WI 54935-4560
(920) 926-8340
Taxonomy
Speciality
Code
Description
License number
State
208000000X
Pediatrics Physician
Primary
42205
WI
208000000X
Pediatrics Physician
N5427
TX
Other
Other identifiers
Code
Description
Identifier
Issuer
State
01
—
12560
DEAN
WI
05
—
33332600
—
WI
01
—
390807236FA
UNITY
WI
01
—
WI01F1
JOHN DEERE
WI
Enumeration date
11/21/2005
Last updated
12/16/2020
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