Provider Demographics
NPI:1962286476
Name:KLEIN, PATRICK JOHN (APNP)
Entity type:Individual
Prefix:
First Name:PATRICK
Middle Name:JOHN
Last Name:KLEIN
Suffix:
Gender:M
Credentials:APNP
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:704 N MAIN ST
Mailing Address - Street 2:
Mailing Address - City:DODGEVILLE
Mailing Address - State:WI
Mailing Address - Zip Code:53533-1134
Mailing Address - Country:US
Mailing Address - Phone:608-412-5113
Mailing Address - Fax:
Practice Address - Street 1:833 S IOWA ST STE 102
Practice Address - Street 2:
Practice Address - City:DODGEVILLE
Practice Address - State:WI
Practice Address - Zip Code:53533-1900
Practice Address - Country:US
Practice Address - Phone:608-935-3301
Practice Address - Fax:608-935-3823
Is Sole Proprietor?:No
Enumeration Date:2023-08-24
Last Update Date:2023-09-15
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WI14354-33363L00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363L00000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse Practitioner
Provider Identifiers
StateIdentifier IDID TypeIssuer
WI1962286476Medicaid