Provider Demographics
NPI:1083671259
Name:KREGER, VIRGINIA LYND (LPN)
Entity type:Individual
Prefix:MRS
First Name:VIRGINIA
Middle Name:LYND
Last Name:KREGER
Suffix:
Gender:F
Credentials:LPN
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:W3675 LOWER HEBRON RD
Mailing Address - Street 2:
Mailing Address - City:FORT ATKINSON
Mailing Address - State:WI
Mailing Address - Zip Code:53538-8407
Mailing Address - Country:US
Mailing Address - Phone:920-650-0246
Mailing Address - Fax:920-568-1557
Practice Address - Street 1:W3675 LOWER HEBRON RD
Practice Address - Street 2:
Practice Address - City:FORT ATKINSON
Practice Address - State:WI
Practice Address - Zip Code:53538-8407
Practice Address - Country:US
Practice Address - Phone:920-650-0246
Practice Address - Fax:920-568-1557
Is Sole Proprietor?:Not Answered
Enumeration Date:2006-04-29
Last Update Date:2007-07-09
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WI31064-031164W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes164W00000XNursing Service ProvidersLicensed Practical Nurse
Provider Identifiers
StateIdentifier IDID TypeIssuer
WI39884100Medicaid