Individual
KATHLEEN JEANEEN SUMMERS
Active
Sole proprietor
No
Provider details
NPI number
Gender
F
Credential
NURSE PRACTITIONER
Contact information
Practice address
9244 29TH AVE, KENOSHA, WI 53143-6602
(262) 694-0080
Mailing address
9019 29TH AVE, KENOSHA, WI 53143-6601
(262) 914-1063
Taxonomy
Speciality
Code
Description
License number
State
225200000X
Physical Therapy Assistant
718-19
WI
363LA2200X
Adult Health Nurse Practitioner
Primary
10887-33
WI
Other
Enumeration date
11/21/2012
Last updated
06/30/2021
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