Kirsten Canavan, FNP – Family Nurse Practitioner

Key facts

NPI: 1730815291
Entity type: Individual (NPI type 1)
Primary specialty: Family Nurse Practitioner 363LF0000X
License: 12101-33 (WI)
Practice address: W63N545 Hanover Ave
Cedarburg, WI 53012-1917
Phone: (262) 421-5133
NPI assigned: Jul 27, 2022
Sex: Female
Sole proprietor: Yes

Organizations & group practices 1

Organizations this provider is connected to: Medicare benefit reassignments (the organization bills Medicare for this provider’s services), Care Compare group memberships and National Provider Directory roles.

Boca Pediatric Group Pediatrics Physician · Boca Raton, FL · NPI 1154402097

NPD (past)

Medicare participation

Medicare fee-for-service enrollment: Not listed in the public Medicare enrollment file

National Provider Directory

Medicare enrollment (NPD): Yes
Credentials: Nurse Practitioner

State licenses

License	State	Type	Specialty
12101	WI	MD	Clinical Social Worker
12101-33	WI	MD	Family Nurse Practitioner

Practice roles

Organization	Specialty	Status	New patients
Boca Pediatric Group		Past	Accepting new patients

Specialties & licenses

Specialty (taxonomy)	Code	License	State	Primary
Family Nurse Practitioner	363LF0000X	12101-33	WI	Yes

Addresses

Primary practice location

W63N545 Hanover Ave
Cedarburg, WI 53012-1917

Mailing address

10264 W Parkedge Cir
Franklin, WI 53132-1234
Phone (570) 862-9650

Other providers in Cedarburg, WI

Jay Timothy Brogelman
Joanne Buettner, PTA
Anthony Michael Burant, DDS
Serena Bye, M.S.
Robin Campbell, L.AC.
Amy Lynn Carter
Kimberly Caverson, MS, CCC/SLP
Cedar Creek Eye Assciates, LLC
Cedar Springs Health & Rehabilitation Center
Cedarburg Al, LLC

All providers in Cedarburg, WI · Family Nurse Practitioner in Wisconsin

Sources for this page

NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Record last updated by the provider on Jul 27, 2022. Information in NPPES is self-reported and not verified by CMS.
NUCC Health Care Provider Taxonomy: specialty names.
National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.

Verify at the official NPI Registry.