Provider Demographics
NPI:1871728253
Name:KLOTZ, CAROLYN J (APNP)
Entity type:Individual
Prefix:
First Name:CAROLYN
Middle Name:J
Last Name:KLOTZ
Suffix:
Gender:F
Credentials:APNP
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
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Other - Credentials:
Mailing Address - Street 1:13255 W BLUEMOUND RD
Mailing Address - Street 2:SUITE 103
Mailing Address - City:BROOKFIELD
Mailing Address - State:WI
Mailing Address - Zip Code:53005-6245
Mailing Address - Country:US
Mailing Address - Phone:262-796-0600
Mailing Address - Fax:262-796-0700
Practice Address - Street 1:13255 W BLUEMOUND RD
Practice Address - Street 2:SUITE 103
Practice Address - City:BROOKFIELD
Practice Address - State:WI
Practice Address - Zip Code:53005-6245
Practice Address - Country:US
Practice Address - Phone:262-796-0600
Practice Address - Fax:262-796-0700
Is Sole Proprietor?:No
Enumeration Date:2009-05-28
Last Update Date:2018-03-17
Deactivation Date:
Deactivation Code:
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Provider Licenses
StateLicense IDTaxonomies
WI4675-33363LP0808X, 363LA2200X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LA2200XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerAdult Health
No363LP0808XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerPsychiatric/Mental Health