Provider Demographics
NPI:1588909402
Name:CULVER, KELLI DANIELLE (APRN, NP-C)
Entity type:Individual
Prefix:
First Name:KELLI
Middle Name:DANIELLE
Last Name:CULVER
Suffix:
Gender:F
Credentials:APRN, NP-C
Other - Prefix:
Other - First Name:KELLI
Other - Middle Name:
Other - Last Name:GRENZ
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:
Mailing Address - Street 1:216 3RD ST W STE 201
Mailing Address - Street 2:
Mailing Address - City:ASHLAND
Mailing Address - State:WI
Mailing Address - Zip Code:54806-1659
Mailing Address - Country:US
Mailing Address - Phone:715-685-0656
Mailing Address - Fax:
Practice Address - Street 1:216 3RD ST W STE 201
Practice Address - Street 2:
Practice Address - City:ASHLAND
Practice Address - State:WI
Practice Address - Zip Code:54806
Practice Address - Country:US
Practice Address - Phone:715-685-0656
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2012-12-04
Last Update Date:2019-09-05
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MN2227496163W00000X
WI25001130163W00000X
MN486363LF0000X
WI956933363L00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes363L00000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse Practitioner
No163W00000XNursing Service ProvidersRegistered NurseGroup - Single Specialty
No363LF0000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerFamilyGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
NE099827011Medicare PIN
NEP01177733Medicare PIN