Provider Demographics
NPI:1386952182
Name:PENDL, KRISTIN M (LAC)
Entity type:Individual
Prefix:
First Name:KRISTIN
Middle Name:M
Last Name:PENDL
Suffix:
Gender:F
Credentials:LAC
Other - Prefix:
Other - First Name:KRISTIN
Other - Middle Name:M
Other - Last Name:CONNOR
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:LAC
Mailing Address - Street 1:6041 MONONA DR
Mailing Address - Street 2:SUITE 101
Mailing Address - City:MONONA
Mailing Address - State:WI
Mailing Address - Zip Code:53716-3964
Mailing Address - Country:US
Mailing Address - Phone:608-222-0250
Mailing Address - Fax:
Practice Address - Street 1:6041 MONONA DR
Practice Address - Street 2:SUITE 101
Practice Address - City:MONONA
Practice Address - State:WI
Practice Address - Zip Code:53716-3964
Practice Address - Country:US
Practice Address - Phone:608-222-0250
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2010-09-15
Last Update Date:2013-07-02
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WI621-055171100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes171100000XOther Service ProvidersAcupuncturist