Provider Demographics
NPI:1912478835
Name:HUEBSCHMAN, KAELYN E (APNP)
Entity type:Individual
Prefix:
First Name:KAELYN
Middle Name:E
Last Name:HUEBSCHMAN
Suffix:
Gender:F
Credentials:APNP
Other - Prefix:
Other - First Name:KAELYN
Other - Middle Name:E
Other - Last Name:FREIBERG
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:
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 1:700 N WESTHAVEN DR
Practice Address - Street 2:
Practice Address - City:OSHKOSH
Practice Address - State:WI
Practice Address - Zip Code:54904-6947
Practice Address - Country:US
Practice Address - Phone:920-303-8700
Practice Address - Fax:920-456-5590
Is Sole Proprietor?:No
Enumeration Date:2018-12-17
Last Update Date:2025-01-27
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WI8995363L00000X, 363L00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363L00000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse Practitioner
Provider Identifiers
StateIdentifier IDID TypeIssuer
WI100085218Medicaid