Provider Demographics
NPI:1154947851
Name:BASTRESS, KRISTIAN NOELLE (DNP, APNP, FNP-BC)
Entity type:Individual
Prefix:MRS
First Name:KRISTIAN
Middle Name:NOELLE
Last Name:BASTRESS
Suffix:
Gender:F
Credentials:DNP, APNP, FNP-BC
Other - Prefix:
Other - First Name:KRISTIAN
Other - Middle Name:NOELLE
Other - Last Name:JOHANNES
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:
Mailing Address - Street 1:N9052 LILAC RD
Mailing Address - Street 2:
Mailing Address - City:MENASHA
Mailing Address - State:WI
Mailing Address - Zip Code:54952-8115
Mailing Address - Country:US
Mailing Address - Phone:920-379-1073
Mailing Address - Fax:
Practice Address - Street 1:1855 S KOELLER ST
Practice Address - Street 2:
Practice Address - City:OSHKOSH
Practice Address - State:WI
Practice Address - Zip Code:54902-6186
Practice Address - Country:US
Practice Address - Phone:920-223-7100
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2020-06-19
Last Update Date:2020-12-10
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WI10195-33363LF0000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LF0000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerFamily