Provider Demographics
NPI:1962887885
Name:TAUER, KILEE
Entity type:Individual
Prefix:
First Name:KILEE
Middle Name:
Last Name:TAUER
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:506 E BRIDGE ST
Mailing Address - Street 2:
Mailing Address - City:REDWOOD FALLS
Mailing Address - State:MN
Mailing Address - Zip Code:56283-1168
Mailing Address - Country:US
Mailing Address - Phone:507-627-7537
Mailing Address - Fax:507-627-7539
Practice Address - Street 1:506 E BRIDGE ST
Practice Address - Street 2:
Practice Address - City:REDWOOD FALLS
Practice Address - State:MN
Practice Address - Zip Code:56283-1168
Practice Address - Country:US
Practice Address - Phone:507-627-7537
Practice Address - Fax:507-627-7539
Is Sole Proprietor?:No
Enumeration Date:2015-07-21
Last Update Date:2016-11-11
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MN11858363A00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363A00000XPhysician Assistants & Advanced Practice Nursing ProvidersPhysician Assistant