Provider Demographics
NPI:1619198017
Name:SCHAEFER, CHRISTINE LYNN (RN,RCS)
Entity Type:Individual
Prefix:
First Name:CHRISTINE
Middle Name:LYNN
Last Name:SCHAEFER
Suffix:
Gender:F
Credentials:RN,RCS
Other - Prefix:
Other - First Name:CHRISTINE
Other - Middle Name:LYNN
Other - Last Name:WEINA
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:RN
Mailing Address - Street 1:5004 VISTA RD
Mailing Address - Street 2:
Mailing Address - City:MANITOWOC
Mailing Address - State:WI
Mailing Address - Zip Code:54220-9378
Mailing Address - Country:US
Mailing Address - Phone:920-684-9717
Mailing Address - Fax:
Practice Address - Street 1:5004 VISTA RD
Practice Address - Street 2:
Practice Address - City:MANITOWOC
Practice Address - State:WI
Practice Address - Zip Code:54220-9378
Practice Address - Country:US
Practice Address - Phone:920-684-9717
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2007-05-01
Last Update Date:2007-07-09
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WI35025800163W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes163W00000XNursing Service ProvidersRegistered Nurse
Provider Identifiers
StateIdentifier IDID TypeIssuer
WI86287030OtherRN LICENSE
WI35025800Medicaid