Provider Demographics
NPI:1215717632
Name:KUCHELMEISTER, BRIANNA LYNN (NP)
Entity type:Individual
Prefix:MS
First Name:BRIANNA
Middle Name:LYNN
Last Name:KUCHELMEISTER
Suffix:
Gender:F
Credentials:NP
Other - Prefix:
Other - First Name:BRIANNA
Other - Middle Name:LYNN
Other - Last Name:VANDENBERG
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:
Mailing Address - Street 1:N3977 MCHUGH RD
Mailing Address - Street 2:
Mailing Address - City:FREEDOM
Mailing Address - State:WI
Mailing Address - Zip Code:54130
Mailing Address - Country:US
Mailing Address - Phone:920-256-1748
Mailing Address - Fax:
Practice Address - Street 1:333 PINE RIDGE BLVD
Practice Address - Street 2:
Practice Address - City:WAUSAU
Practice Address - State:WI
Practice Address - Zip Code:54401
Practice Address - Country:US
Practice Address - Phone:800-283-2881
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2023-10-03
Last Update Date:2024-01-23
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WI13782363L00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363L00000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse Practitioner