Provider Demographics
NPI:1194316968
Name:DOEDE, KRISTIN D (FNP)
Entity type:Individual
Prefix:
First Name:KRISTIN
Middle Name:D
Last Name:DOEDE
Suffix:
Gender:F
Credentials:FNP
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1314 GRAND AVE
Mailing Address - Street 2:
Mailing Address - City:WAUSAU
Mailing Address - State:WI
Mailing Address - Zip Code:54403-6640
Mailing Address - Country:US
Mailing Address - Phone:715-301-8260
Mailing Address - Fax:
Practice Address - Street 1:6303 SCHOFIELD AVE
Practice Address - Street 2:
Practice Address - City:WESTON
Practice Address - State:WI
Practice Address - Zip Code:54476-4352
Practice Address - Country:US
Practice Address - Phone:715-393-4092
Practice Address - Fax:866-885-5412
Is Sole Proprietor?:No
Enumeration Date:2021-02-03
Last Update Date:2022-10-18
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WI162001363LF0000X
WI10851-33363LF0000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LF0000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerFamily