Provider Demographics
NPI:1366552846
Name:RUPERT, KRISTI L (ARNP)
Entity type:Individual
Prefix:
First Name:KRISTI
Middle Name:L
Last Name:RUPERT
Suffix:
Gender:F
Credentials:ARNP
Other - Prefix:
Other - First Name:KRISTI
Other - Middle Name:L
Other - Last Name:SMITH DAMAI
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:
Mailing Address - Street 1:5000 W CHAMBERS ST
Mailing Address - Street 2:SUITE 2222
Mailing Address - City:MILWAUKEE
Mailing Address - State:WI
Mailing Address - Zip Code:53210-1650
Mailing Address - Country:US
Mailing Address - Phone:414-874-4316
Mailing Address - Fax:414-874-4160
Practice Address - Street 1:5000 W CHAMBERS ST
Practice Address - Street 2:SUITE 2222
Practice Address - City:MILWAUKEE
Practice Address - State:WI
Practice Address - Zip Code:53210-1650
Practice Address - Country:US
Practice Address - Phone:414-874-4316
Practice Address - Fax:414-874-4160
Is Sole Proprietor?:No
Enumeration Date:2006-08-30
Last Update Date:2010-11-17
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WI120605363L00000X
WI2678363L00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363L00000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse Practitioner
Provider Identifiers
StateIdentifier IDID TypeIssuer
WIQ68827Medicare UPIN
WI027473840Medicare ID - Type Unspecified