Individual
KATHERINE THERESE NIMKE
Active
Sole proprietor
No
Provider details
NPI number
Gender
F
Credential
M.D.
Contact information
Practice address
1686 EISENHOWER RD, DE PERE, WI 54115-8145
(920) 496-4700
Mailing address
PO BOX 19070, GREEN BAY, WI 54307-9070
(920) 496-4700
Taxonomy
Speciality
Code
Description
License number
State
207Q00000X
Family Medicine Physician
50820
MN
207Q00000X
Family Medicine Physician
Primary
54831-020
WI
Other
Other identifiers
Code
Description
Identifier
Issuer
State
01
—
0130942
MEDICA
—
01
—
223K3FR
BCBS MN
MN
05
—
280678000
—
MN
01
—
P00633146
RAILROAD MEDICARE
—
Enumeration date
08/06/2007
Last updated
06/28/2019
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