Individual
MATTHEW KINSERDAHL
Active
Sole proprietor
No
Provider details
NPI number
Gender
Man
Contact information
Practice address
9532 E 16 FRONTAGE RD, ONALASKA, WI 54650-6739
(608) 783-0506
Mailing address
9532 E 16 FRONTAGE RD, ONALASKA, WI 54650-6739
Taxonomy
Speciality
Code
Description
License number
State
163WA0400X
Addiction (Substance Use Disorder) Registered Nurse
Primary
222599-30
WI
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
1003150004
—
WI
Enumeration date
10/09/2018
Last updated
10/09/2018
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