Provider Demographics
NPI:1013201474
Name:SCHILLINGER, KIM DENISE (RN BSN)
Entity Type:Individual
Prefix:
First Name:KIM
Middle Name:DENISE
Last Name:SCHILLINGER
Suffix:
Gender:F
Credentials:RN BSN
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:5303 CAMP PHILLIPS RD
Mailing Address - Street 2:
Mailing Address - City:SCHOFIELD
Mailing Address - State:WI
Mailing Address - Zip Code:54476-2610
Mailing Address - Country:US
Mailing Address - Phone:715-359-7451
Mailing Address - Fax:
Practice Address - Street 1:5303 CAMP PHILLIPS RD
Practice Address - Street 2:
Practice Address - City:SCHOFIELD
Practice Address - State:WI
Practice Address - Zip Code:54476-2610
Practice Address - Country:US
Practice Address - Phone:715-359-7451
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2011-06-02
Last Update Date:2011-06-02
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WI11517030163W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes163W00000XNursing Service ProvidersRegistered Nurse