Individual
KRYSTINE AMBER BREEDLOVE
Active
Sole proprietor
No
Provider details
NPI number
Gender
F
Credential
ACNPC-AG
Contact information
Practice address
210 WISCONSIN AMERICAN DR, FOND DU LAC, WI 54937-2999
(920) 907-7500
Mailing address
PO BOX 735044, CHICAGO, IL 60673-5044
(800) 326-2250
Taxonomy
Speciality
Code
Description
License number
State
163W00000X
Registered Nurse
RN201982
AZ
363L00000X
Nurse Practitioner
17458-33
WI
363L00000X
Nurse Practitioner
Primary
249005
AZ
363LA2100X
Acute Care Nurse Practitioner
249005
AZ
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
100390999
—
WI
Enumeration date
11/17/2020
Last updated
02/24/2026
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