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Contact Information

KRISTEN J BROCKDORF, PA-C
2500 E CAPITOL DR
APPLETON, WI54911-8735
 Phone: 920-364-3600
 Fax: 920-364-3900
 Website:
 

Specialty

Taxonomy Code Specialty Code Provider Type

Physician Assistant

363A00000X 97 Physician Assistant
 

Medical

363AM0700X 97 Physician Assistant
 

Medical Technologist

246QM0706X
Indicates primary specialty

NPI Profile & details for KRISTEN J BROCKDORF · (Female)

NPI # 1558882555
Status Active
Credentials PA-C (Physician Assistant-Certified)
Entity Individual
Enumeration date 06/29/2017
Last updated 09/08/2022 - About 4 years ago
Sole proprietor 1 No
Identifiers
  • WI License # 249004
  • WI License # 404123
Hospital affiliation(s)
  • APPLETON MED CTR - (Acute Care)
    1818 N MEADE ST
    APPLETON, WI 54911
  • SHAWANO MED CTR - (Critical Access)
    309 N BARTLETTE ST
    SHAWANO, WI 54166
  • THEDA CLARK MED CTR - (Acute Care)
    130 2ND ST
    NEENAH, WI 54956
1 A sole proprietor/sole proprietorship is an individual, and as such, is eligible for a single NPI number. The sole proprietor must apply for the NPI number using his or her own Social Security Number (SSN), not an Employer Identification Number (EIN) even if he/she has an EIN.

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