Individual
KELLY NICOLE SIVERHUS
Active
Sole proprietor
No
Provider details
NPI number
Gender
F
Credential
PA-C, MS, RDN, CD
Contact information
Practice address
9200 W WISCONSIN AVE, MILWAUKEE, WI 53226-3522
(414) 805-7782
Mailing address
9200 W WISCONSIN AVE, MILWAUKEE, WI 53226-3522
(414) 805-7782
Taxonomy
Speciality
Code
Description
License number
State
133V00000X
Registered Dietitian
3755-29
WI
363A00000X
Physician Assistant
Primary
8121-23
WI
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
1972269876
—
WI
Enumeration date
11/15/2021
Last updated
12/13/2024
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