Provider Demographics
NPI:1659550853
Name:SCHULLER, JODEEN DIANE (RN)
Entity Type:Individual
Prefix:
First Name:JODEEN
Middle Name:DIANE
Last Name:SCHULLER
Suffix:
Gender:F
Credentials:RN
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:S58W22460 WEILAND DR
Mailing Address - Street 2:
Mailing Address - City:WAUKESHA
Mailing Address - State:WI
Mailing Address - Zip Code:53189-9666
Mailing Address - Country:US
Mailing Address - Phone:262-547-7393
Mailing Address - Fax:
Practice Address - Street 1:S58W22460 WEILAND DR
Practice Address - Street 2:
Practice Address - City:WAUKESHA
Practice Address - State:WI
Practice Address - Zip Code:53189-9666
Practice Address - Country:US
Practice Address - Phone:262-547-7393
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2007-10-24
Last Update Date:2007-10-24
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WI163WH0200X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes163WH0200XNursing Service ProvidersRegistered NurseHome Health
Provider Identifiers
StateIdentifier IDID TypeIssuer
WI39858900Medicaid