Provider Demographics
NPI:1124633920
Name:KRAUSE, JOELLYN (APNP)
Entity type:Individual
Prefix:
First Name:JOELLYN
Middle Name:
Last Name:KRAUSE
Suffix:
Gender:F
Credentials:APNP
Other - Prefix:
Other - First Name:JOELLYN
Other - Middle Name:
Other - Last Name:WEIBEL
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:
Mailing Address - Street 1:1520 MADISON AVE
Mailing Address - Street 2:
Mailing Address - City:FORT ATKINSON
Mailing Address - State:WI
Mailing Address - Zip Code:53538-3100
Mailing Address - Country:US
Mailing Address - Phone:920-563-5500
Mailing Address - Fax:
Practice Address - Street 1:1520 MADISON AVE
Practice Address - Street 2:
Practice Address - City:FORT ATKINSON
Practice Address - State:WI
Practice Address - Zip Code:53538-3100
Practice Address - Country:US
Practice Address - Phone:920-563-5500
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2020-09-09
Last Update Date:2023-03-13
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WI10351-33363LF0000X, 363L00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363L00000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse Practitioner
No363LF0000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerFamily