Provider Demographics
NPI:1285957373
Name:GREIVELDINGER, KIM ANN (BSN, RNC)
Entity type:Individual
Prefix:MS
First Name:KIM
Middle Name:ANN
Last Name:GREIVELDINGER
Suffix:
Gender:F
Credentials:BSN, RNC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:N48W16443 LONE OAK LN
Mailing Address - Street 2:
Mailing Address - City:MENOMONEE FALLS
Mailing Address - State:WI
Mailing Address - Zip Code:53051-6641
Mailing Address - Country:US
Mailing Address - Phone:262-352-8178
Mailing Address - Fax:
Practice Address - Street 1:N48W16443 LONE OAK LN
Practice Address - Street 2:
Practice Address - City:MENOMONEE FALLS
Practice Address - State:WI
Practice Address - Zip Code:53051-6641
Practice Address - Country:US
Practice Address - Phone:262-352-8178
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2010-03-03
Last Update Date:2010-03-03
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WI87782-30163WH0200X, 163WX0002X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes163WH0200XNursing Service ProvidersRegistered NurseHome Health
No163WX0002XNursing Service ProvidersRegistered NurseObstetric, High-Risk