Provider Demographics
NPI:1124866322
Name:TENNIE, KIRSTEN LEAH (AGPCNP-BC, APNP)
Entity type:Individual
Prefix:
First Name:KIRSTEN
Middle Name:LEAH
Last Name:TENNIE
Suffix:
Gender:F
Credentials:AGPCNP-BC, APNP
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:5901 DENDRON LN
Mailing Address - Street 2:
Mailing Address - City:GREENDALE
Mailing Address - State:WI
Mailing Address - Zip Code:53129-2337
Mailing Address - Country:US
Mailing Address - Phone:414-587-1668
Mailing Address - Fax:
Practice Address - Street 1:5901 DENDRON LN
Practice Address - Street 2:
Practice Address - City:GREENDALE
Practice Address - State:WI
Practice Address - Zip Code:53129-2337
Practice Address - Country:US
Practice Address - Phone:414-587-1668
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2024-07-20
Last Update Date:2024-07-20
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WI147806-30163WG0000X
WI15309-33364SG0600X, 363LA2200X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LA2200XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerAdult Health
No163WG0000XNursing Service ProvidersRegistered NurseGeneral Practice
No364SG0600XPhysician Assistants & Advanced Practice Nursing ProvidersClinical Nurse SpecialistGerontology