Provider Demographics
NPI:1215331087
Name:SCHUCHARDT, KRISTINE LYNN (LPN)
Entity type:Individual
Prefix:MS
First Name:KRISTINE
Middle Name:LYNN
Last Name:SCHUCHARDT
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 1:2137 E BROADWAY UNIT A
Mailing Address - Street 2:
Mailing Address - City:WAUKESHA
Mailing Address - State:WI
Mailing Address - Zip Code:53186-8162
Mailing Address - Country:US
Mailing Address - Phone:262-650-6321
Mailing Address - Fax:
Practice Address - Street 1:2137A E BROADWAY STREET
Practice Address - Street 2:
Practice Address - City:WAUKESHA
Practice Address - State:WI
Practice Address - Zip Code:53186-8162
Practice Address - Country:US
Practice Address - Phone:262-650-6321
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2014-10-22
Last Update Date:2014-10-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WI23489-31164W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes164W00000XNursing Service ProvidersLicensed Practical Nurse