Provider Demographics
NPI:1215932439
Name:SCHULTZ, KRISTIN N (PA-C)
Entity type:Individual
Prefix:
First Name:KRISTIN
Middle Name:N
Last Name:SCHULTZ
Suffix:
Gender:F
Credentials:PA-C
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:2534 NORTHERN HARRIER PASS
Mailing Address - Street 2:
Mailing Address - City:GREEN BAY
Mailing Address - State:WI
Mailing Address - Zip Code:54313-3996
Mailing Address - Country:US
Mailing Address - Phone:920-544-4467
Mailing Address - Fax:920-496-4747
Practice Address - Street 1:1715 DOUSMAN STREET
Practice Address - Street 2:
Practice Address - City:GREEN BAY
Practice Address - State:WI
Practice Address - Zip Code:54307-9070
Practice Address - Country:US
Practice Address - Phone:920-496-4740
Practice Address - Fax:920-496-4747
Is Sole Proprietor?:No
Enumeration Date:2005-06-15
Last Update Date:2023-03-07
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WI1886-023363AS0400X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363AS0400XPhysician Assistants & Advanced Practice Nursing ProvidersPhysician AssistantSurgical
Provider Identifiers
StateIdentifier IDID TypeIssuer
TNML0973001OtherDEA CERTIFICATE
TNML0973001OtherDEA CERTIFICATE
WI07028-0141Medicare PIN