Provider Demographics
NPI:1306384268
Name:RUSSELL, KRISTEN N (APNP)
Entity Type:Individual
Prefix:
First Name:KRISTEN
Middle Name:N
Last Name:RUSSELL
Suffix:
Gender:F
Credentials:APNP
Other - Prefix:
Other - First Name:KRISTEN
Other - Middle Name:N
Other - Last Name:SCHMITZ
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:NP
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:920-497-7783
Mailing Address - Fax:
Practice Address - Street 1:2301 S ONEIDA ST
Practice Address - Street 2:
Practice Address - City:ASHWAUBENON
Practice Address - State:WI
Practice Address - Zip Code:54304-5230
Practice Address - Country:US
Practice Address - Phone:920-497-7783
Practice Address - Fax:920-497-7789
Is Sole Proprietor?:No
Enumeration Date:2017-02-10
Last Update Date:2023-08-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WI7518363L00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363L00000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse Practitioner
Provider Identifiers
StateIdentifier IDID TypeIssuer
WI100064737Medicaid