Provider Demographics
NPI:1194271312
Name:TREML, KATHRYN PAGE (APNP)
Entity type:Individual
Prefix:
First Name:KATHRYN
Middle Name:PAGE
Last Name:TREML
Suffix:
Gender:F
Credentials:APNP
Other - Prefix:
Other - First Name:KATHRYN
Other - Middle Name:A
Other - Last Name:PAGE
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:APNP
Mailing Address - Street 1:3021 VOYAGER DR
Mailing Address - Street 2:
Mailing Address - City:GREEN BAY
Mailing Address - State:WI
Mailing Address - Zip Code:54311-8303
Mailing Address - Country:US
Mailing Address - Phone:920-445-7222
Mailing Address - Fax:920-445-7289
Practice Address - Street 1:301 BAY PARK SQUARE
Practice Address - Street 2:
Practice Address - City:GREEN BAY
Practice Address - State:WI
Practice Address - Zip Code:54304-5401
Practice Address - Country:US
Practice Address - Phone:920-592-9475
Practice Address - Fax:920-592-9479
Is Sole Proprietor?:No
Enumeration Date:2016-08-28
Last Update Date:2019-03-18
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WI7148-33363L00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363L00000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse Practitioner
Provider Identifiers
StateIdentifier IDID TypeIssuer
WIK400325883Medicare Oscar/Certification