Provider Demographics
NPI:1053008466
Name:KLAAS, NICOLE M (APNP)
Entity type:Individual
Prefix:
First Name:NICOLE
Middle Name:M
Last Name:KLAAS
Suffix:
Gender:F
Credentials:APNP
Other - Prefix:
Other - First Name:NICOLE
Other - Middle Name:M
Other - Last Name:WILLIAMS
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:
Mailing Address - Street 1:PO BOX 263
Mailing Address - Street 2:
Mailing Address - City:MONTFORT
Mailing Address - State:WI
Mailing Address - Zip Code:53569-0263
Mailing Address - Country:US
Mailing Address - Phone:608-778-6654
Mailing Address - Fax:
Practice Address - Street 1:316 W SPRING ST
Practice Address - Street 2:
Practice Address - City:DODGEVILLE
Practice Address - State:WI
Practice Address - Zip Code:53533-1300
Practice Address - Country:US
Practice Address - Phone:608-276-4660
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2023-04-18
Last Update Date:2023-04-18
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WI13851-33363LF0000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LF0000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerFamily