Provider Demographics
NPI:1053339796
Name:KIESLICH, JANET E (NP)
Entity type:Individual
Prefix:
First Name:JANET
Middle Name:E
Last Name:KIESLICH
Suffix:
Gender:F
Credentials:NP
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:3805A SPRING ST STE 330
Mailing Address - Street 2:
Mailing Address - City:RACINE
Mailing Address - State:WI
Mailing Address - Zip Code:53405-1600
Mailing Address - Country:US
Mailing Address - Phone:262-687-8640
Mailing Address - Fax:262-687-8641
Practice Address - Street 1:3805A SPRING ST STE 330
Practice Address - Street 2:
Practice Address - City:RACINE
Practice Address - State:WI
Practice Address - Zip Code:53405-1600
Practice Address - Country:US
Practice Address - Phone:262-687-8640
Practice Address - Fax:262-687-8641
Is Sole Proprietor?:No
Enumeration Date:2006-07-18
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WI1518363LC1500X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LC1500XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerCommunity Health
Provider Identifiers
StateIdentifier IDID TypeIssuer
P14313Medicare UPIN