Provider Demographics
NPI:1437179520
Name:ADAMO, KRISTEN (PA)
Entity type:Individual
Prefix:
First Name:KRISTEN
Middle Name:
Last Name:ADAMO
Suffix:
Gender:F
Credentials:PA
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:4855 S MOORLAND RD
Mailing Address - Street 2:SUITE 150
Mailing Address - City:NEW BERLIN
Mailing Address - State:WI
Mailing Address - Zip Code:53151-7494
Mailing Address - Country:US
Mailing Address - Phone:414-425-5660
Mailing Address - Fax:414-425-9803
Practice Address - Street 1:4855 S MOORLAND RD
Practice Address - Street 2:SUITE 150
Practice Address - City:NEW BERLIN
Practice Address - State:WI
Practice Address - Zip Code:53151-7494
Practice Address - Country:US
Practice Address - Phone:414-425-5660
Practice Address - Fax:414-425-9803
Is Sole Proprietor?:No
Enumeration Date:2006-07-20
Last Update Date:2016-11-16
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WI1791-023363A00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363A00000XPhysician Assistants & Advanced Practice Nursing ProvidersPhysician Assistant
Provider Identifiers
StateIdentifier IDID TypeIssuer
WI1437179520Medicaid