Individual
KRISTA BOTSFORD
Active
Sole proprietor
No
Provider details
NPI number
Gender
F
Credential
PA
Contact information
Practice address
9004 HOLLIROB LN, WAUSAU, WI 54403-9171
(715) 845-5532
Mailing address
9004 HOLLIROB LN, WAUSAU, WI 54403-9171
(715) 845-5532
Taxonomy
Speciality
Code
Description
License number
State
363A00000X
Physician Assistant
Primary
640
WI
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
42934000
—
WI
Enumeration date
09/26/2006
Last updated
01/26/2013
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