Provider Demographics
NPI:1386148088
Name:BREITENMOSER, KATHERINE MICHELLE (CNM LM)
Entity type:Individual
Prefix:
First Name:KATHERINE
Middle Name:MICHELLE
Last Name:BREITENMOSER
Suffix:
Gender:F
Credentials:CNM LM
Other - Prefix:
Other - First Name:KATHERINE
Other - Middle Name:MICHELLE
Other - Last Name:HUBER
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:
Mailing Address - Street 1:W6982 JOE SNOW RD
Mailing Address - Street 2:
Mailing Address - City:MERRILL
Mailing Address - State:WI
Mailing Address - Zip Code:54452-9710
Mailing Address - Country:US
Mailing Address - Phone:715-581-0888
Mailing Address - Fax:715-997-7019
Practice Address - Street 1:W6982 JOE SNOW RD
Practice Address - Street 2:
Practice Address - City:MERRILL
Practice Address - State:WI
Practice Address - Zip Code:54452-9710
Practice Address - Country:US
Practice Address - Phone:715-581-0888
Practice Address - Fax:715-997-7019
Is Sole Proprietor?:Yes
Enumeration Date:2018-03-19
Last Update Date:2018-03-19
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WI217-49176B00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes176B00000XOther Service ProvidersMidwife