Individual
KRISTEN JEANNE BROCKDORF
Active
Sole proprietor
No
Provider details
NPI number
Gender
F
Credential
PA-C
Contact information
Practice address
2500 E CAPITOL DR, APPLETON, WI 54911-8735
(920) 364-3600
(920) 364-3900
Mailing address
2500 E CAPITOL DR, APPLETON, WI 54911-8735
(920) 364-3600
(920) 364-3900
Taxonomy
Speciality
Code
Description
License number
State
246QM0706X
Medical Technologist
249004
WI
363A00000X
Physician Assistant
Primary
404123
WI
363AM0700X
Medical Physician Assistant
404123
WI
Other
Enumeration date
06/29/2017
Last updated
09/08/2022
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