Provider Demographics
NPI:1285966101
Name:SHTULBERG, KRISTIN M (RN, APN)
Entity type:Individual
Prefix:MRS
First Name:KRISTIN
Middle Name:M
Last Name:SHTULBERG
Suffix:
Gender:F
Credentials:RN, APN
Other - Prefix:
Other - First Name:KRISTIN
Other - Middle Name:MICHON
Other - Last Name:WHITCOMB
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:RN
Mailing Address - Street 1:PO BOX 735044
Mailing Address - Street 2:
Mailing Address - City:CHICAGO
Mailing Address - State:IL
Mailing Address - Zip Code:60673-5044
Mailing Address - Country:US
Mailing Address - Phone:800-326-2250
Mailing Address - Fax:
Practice Address - Street 1:12203 CORPORATE PKWY
Practice Address - Street 2:
Practice Address - City:MEQUON
Practice Address - State:WI
Practice Address - Zip Code:53092-3388
Practice Address - Country:US
Practice Address - Phone:262-387-8200
Practice Address - Fax:262-387-8239
Is Sole Proprietor?:No
Enumeration Date:2010-02-02
Last Update Date:2024-02-27
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WI171140-30163W00000X
IL041.405240163W00000X
WI6230363LF0000X, 363L00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363L00000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse Practitioner
No163W00000XNursing Service ProvidersRegistered Nurse
No363LF0000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerFamily
Provider Identifiers
StateIdentifier IDID TypeIssuer
WI100043192Medicaid
WI1285966101Medicaid