Provider Demographics
NPI:1164559175
Name:SCHUSTER, KELLY S
Entity Type:Individual
Prefix:
First Name:KELLY
Middle Name:S
Last Name:SCHUSTER
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 1:2045 FRANKLIN STREET
Mailing Address - Street 2:
Mailing Address - City:DENVER
Mailing Address - State:CO
Mailing Address - Zip Code:80231
Mailing Address - Country:US
Mailing Address - Phone:720-536-7456
Mailing Address - Fax:
Practice Address - Street 1:2045 FRANKLIN STREET
Practice Address - Street 2:
Practice Address - City:DENVER
Practice Address - State:CO
Practice Address - Zip Code:80231
Practice Address - Country:US
Practice Address - Phone:303-861-3655
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2007-02-27
Last Update Date:2013-11-12
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CO112537163WG0100X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes163WG0100XNursing Service ProvidersRegistered NurseGastroenterology
Provider Identifiers
StateIdentifier IDID TypeIssuer
014840OtherKAISER-COMMERCIAL NUMBER