Provider Demographics
NPI:1316377849
Name:KREUSCHER, JODI LYN (CRNA)
Entity Type:Individual
Prefix:MRS
First Name:JODI
Middle Name:LYN
Last Name:KREUSCHER
Suffix:
Gender:F
Credentials:CRNA
Other - Prefix:
Other - First Name:JODI
Other - Middle Name:LYN
Other - Last Name:VOSSEKUIL
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:
Mailing Address - Street 1:PO BOX 22487
Mailing Address - Street 2:
Mailing Address - City:GREEN BAY
Mailing Address - State:WI
Mailing Address - Zip Code:54301-3505
Mailing Address - Country:US
Mailing Address - Phone:920-433-7864
Mailing Address - Fax:920-433-6090
Practice Address - Street 1:744 S WEBSTER AVE
Practice Address - Street 2:
Practice Address - City:GREEN BAY
Practice Address - State:WI
Practice Address - Zip Code:54301-3505
Practice Address - Country:US
Practice Address - Phone:920-433-3605
Practice Address - Fax:920-433-3589
Is Sole Proprietor?:Yes
Enumeration Date:2013-11-19
Last Update Date:2020-10-06
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WI13942630163W00000X
WI5800-33367500000X
WI100391367500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes367500000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse Anesthetist, Certified Registered
No163W00000XNursing Service ProvidersRegistered Nurse