Individual
KAMINI S GUPTA
Active
Sole proprietor
No
Provider details
NPI number
Gender
F
Credential
FNP-BC
Contact information
Practice address
2700 W HONADEL BLVD, OAK CREEK, WI 53154-2650
(630) 571-8990
Mailing address
PO BOX 735044, CHICAGO, IL 60673-5044
(800) 326-2250
Taxonomy
Speciality
Code
Description
License number
State
363L00000X
Nurse Practitioner
Primary
9732
WI
363LF0000X
Family Nurse Practitioner
9732
WI
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
100099261
—
WI
Enumeration date
11/19/2019
Last updated
11/05/2024
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