Provider Demographics
NPI:1871562058
Name:DALL-WINTHER, KRISTEN MARJORIE (MD, FAAFP)
Entity type:Individual
Prefix:DR
First Name:KRISTEN
Middle Name:MARJORIE
Last Name:DALL-WINTHER
Suffix:
Gender:F
Credentials:MD, FAAFP
Other - Prefix:DR
Other - First Name:KRISTEN
Other - Middle Name:MARJORIE GREEN
Other - Last Name:LERBERG
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:MD
Mailing Address - Street 1:PO BOX 2
Mailing Address - Street 2:
Mailing Address - City:BIRCHWOOD
Mailing Address - State:WI
Mailing Address - Zip Code:54817-0002
Mailing Address - Country:US
Mailing Address - Phone:715-202-6782
Mailing Address - Fax:715-800-1972
Practice Address - Street 1:101 WEST LOOMIS STREET
Practice Address - Street 2:SUITE A
Practice Address - City:BIRCHWOOD
Practice Address - State:WI
Practice Address - Zip Code:54817
Practice Address - Country:US
Practice Address - Phone:715-202-6782
Practice Address - Fax:715-800-1972
Is Sole Proprietor?:Yes
Enumeration Date:2006-03-17
Last Update Date:2024-06-26
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WI48468-020207Q00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207Q00000XAllopathic & Osteopathic PhysiciansFamily Medicine