Provider Demographics
NPI:1174765143
Name:KAESERMANN, AMBER (REGISTERED NURSE)
Entity type:Individual
Prefix:
First Name:AMBER
Middle Name:
Last Name:KAESERMANN
Suffix:
Gender:F
Credentials:REGISTERED NURSE
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:115 S CONCORD PL
Mailing Address - Street 2:
Mailing Address - City:WATERTOWN
Mailing Address - State:WI
Mailing Address - Zip Code:53094-5137
Mailing Address - Country:US
Mailing Address - Phone:920-261-4841
Mailing Address - Fax:
Practice Address - Street 1:115 S CONCORD PL
Practice Address - Street 2:
Practice Address - City:WATERTOWN
Practice Address - State:WI
Practice Address - Zip Code:53094-5137
Practice Address - Country:US
Practice Address - Phone:920-261-4841
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2009-04-06
Last Update Date:2009-04-06
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WI166234-030163W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes163W00000XNursing Service ProvidersRegistered Nurse