Provider Demographics
NPI:1992935811
Name:COREY, KRISTI KAY (LPN)
Entity type:Individual
Prefix:MRS
First Name:KRISTI
Middle Name:KAY
Last Name:COREY
Suffix:
Gender:F
Credentials:LPN
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1018 BUENA VISTA AVE
Mailing Address - Street 2:
Mailing Address - City:WAUKESHA
Mailing Address - State:WI
Mailing Address - Zip Code:53188-3850
Mailing Address - Country:US
Mailing Address - Phone:262-719-5022
Mailing Address - Fax:
Practice Address - Street 1:1018 BUENA VISTA AVE
Practice Address - Street 2:
Practice Address - City:WAUKESHA
Practice Address - State:WI
Practice Address - Zip Code:53188-3850
Practice Address - Country:US
Practice Address - Phone:262-719-5022
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2009-07-27
Last Update Date:2009-07-27
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WI311089-031164W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes164W00000XNursing Service ProvidersLicensed Practical Nurse