Individual
KELLY SCHULTZ
Active
Sole proprietor
Yes
Provider details
NPI number
Gender
F
Credential
L.P.N.
Contact information
Practice address
3960 SUNNYVALE DR, DEFOREST, WI 53532-2747
(920) 296-8048
Mailing address
3960 SUNNYVALE DR, DEFOREST, WI 53532-2747
Taxonomy
Speciality
Code
Description
License number
State
164W00000X
Licensed Practical Nurse
Primary
31091-30
WI
Other
Enumeration date
03/03/2017
Last updated
03/03/2017
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