Individual
THERESA KOHLRUSCH
Active
Sole proprietor
No
Provider details
NPI number
Gender
F
Credential
NP
Contact information
Practice address
265 GRIFFIN ST E, AMERY, WI 54001-1439
(715) 268-8000
(715) 268-0311
Mailing address
265 GRIFFIN STREET EAST, AMERY, WI 54001
(715) 268-8000
(715) 268-0308
Taxonomy
Speciality
Code
Description
License number
State
363LP0200X
Pediatric Nurse Practitioner
Primary
858
WI
Other
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
—
Enumeration date
07/12/2005
Last updated
05/14/2015
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