Doctor Name: | HEATHER LYNN KUPHAL |
NPI Number: | 1083961833 |
Entity Type Code: | Individual (1) |
Gender: | F |
Credentials: | APNP |
License Number: | 6784-33 |
Business Practice Address: | 430 E Division St Fond Du Lac, WI - 549354560 |
Business Phone Number: | 9209265020 |
Business Fax Number: | |
Mailing Address: | 420 E Division St, FOND DU LAC |
State: | WI |
Postal Code: | 549354560 |
Phone Number: | 9209268340 |
Fax Number: | |
NPI Enumeration Date: | 08/11/2012 |
NPI Last Update Date: | 04/12/2016 |
Replacement NPI: | 0 |
NPI Deactivation Date: | |
NPI Reactivation Date: |
Taxonomy Information: | |
Healthcare Provider Taxonomy: | 363LF0000X |
License Number: | 6784-33 |
Healthcare Provider Taxonomy: (Secondary) | Y |
State: | WI |
Taxonomy Type: | Physician Assistants & Advanced Practice Nursing Providers |
Taxonomy Classification: | Nurse Practitioner |
Taxonomy Specialization: | Family |
Taxonomy Definition: |