Provider Demographics
NPI:1588162697
Name:KRUEGER, CHELSE
Entity type:Individual
Prefix:
First Name:CHELSE
Middle Name:
Last Name:KRUEGER
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:5242 PALFREY RD
Mailing Address - Street 2:
Mailing Address - City:SHULLSBURG
Mailing Address - State:WI
Mailing Address - Zip Code:53586-9459
Mailing Address - Country:US
Mailing Address - Phone:608-732-8784
Mailing Address - Fax:
Practice Address - Street 1:5242 PALFREY RD
Practice Address - Street 2:
Practice Address - City:SHULLSBURG
Practice Address - State:WI
Practice Address - Zip Code:53586-9459
Practice Address - Country:US
Practice Address - Phone:608-732-8784
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2018-01-24
Last Update Date:2018-03-17
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WI168452163W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes163W00000XNursing Service ProvidersRegistered Nurse