Individual
CAROL H KONDRATH
Active
Sole proprietor
No
Provider details
NPI number
Gender
F
Credential
APNP
Contact information
Practice address
1500 N 34TH ST, SUPERIOR, WI 54880-4477
(218) 730-2351
Mailing address
1401 EAST FIRST STREET, DULUTH, MN 55805
(218) 728-4404
(218) 728-4404
Taxonomy
Speciality
Code
Description
License number
State
163W00000X
Registered Nurse
1900003
WI
163WP0808X
Psychiatric/Mental Health Registered Nurse
1900003
WI
363LP0808X
Psychiatric/Mental Health Nurse Practitioner
Primary
1900-033
WI
364S00000X
Clinical Nurse Specialist
1900-033
WI
Other
Other identifiers
Code
Description
Identifier
Issuer
State
01
—
0007-84267
REGULAR MEDICARE
WI
05
—
40945600
—
WI
Enumeration date
05/07/2007
Last updated
05/23/2012
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