Individual
MRS. KENDRA NIEMUTH
Active
Sole proprietor
No
Provider details
NPI number
Gender
F
Credential
RN BSN
Contact information
Practice address
958 FOOTE ST, SEYMOUR, WI 54165-1044
(920) 833-9896
Mailing address
PO BOX 19070, GREEN BAY, WI 54307-9070
(920) 496-4700
Taxonomy
Speciality
Code
Description
License number
State
163W00000X
Registered Nurse
190067-30
WI
363L00000X
Nurse Practitioner
Primary
7736-33
WI
Other
Other identifiers
Code
Description
Identifier
Issuer
State
01
—
7736-33
APNP LICENSE
WI
Enumeration date
05/24/2017
Last updated
03/17/2018
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