Individual
KELLY A KRISTBAUM
Active
Sole proprietor
No
Provider details
NPI number
Gender
F
Credential
NP
Contact information
Practice address
2901 W KINNICKINNIC RIVER PKWY, MILWAUKEE, WI 53215-3677
(414) 649-3750
Mailing address
PO BOX 735044, CHICAGO, IL 60673-5044
(800) 326-2250
Taxonomy
Speciality
Code
Description
License number
State
363L00000X
Nurse Practitioner
Primary
5165
WI
363LA2100X
Acute Care Nurse Practitioner
154594
WI
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
100026864
—
WI
05
—
1215271994
—
WI
Enumeration date
11/19/2012
Last updated
11/20/2024
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