Provider Demographics
NPI:1891522520
Name:SCHRUM, KAYLEE REQUEL
Entity type:Individual
Prefix:
First Name:KAYLEE
Middle Name:REQUEL
Last Name:SCHRUM
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 1:18408 WAYNE ROUTE D
Mailing Address - Street 2:
Mailing Address - City:WAPPAPELLO
Mailing Address - State:MO
Mailing Address - Zip Code:63966-8659
Mailing Address - Country:US
Mailing Address - Phone:573-222-8676
Mailing Address - Fax:
Practice Address - Street 1:18408 WAYNE ROUTE D
Practice Address - Street 2:
Practice Address - City:WAPPAPELLO
Practice Address - State:MO
Practice Address - Zip Code:63966-8659
Practice Address - Country:US
Practice Address - Phone:573-222-8676
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2024-09-17
Last Update Date:2024-09-17
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes247200000XTechnologists, Technicians & Other Technical Service ProvidersTechnician, Other