Provider Demographics
NPI:1689819104
Name:KRUEMMELBEIN, LISA JANE
Entity Type:Individual
Prefix:MRS
First Name:LISA
Middle Name:JANE
Last Name:KRUEMMELBEIN
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:PO BOX 422
Mailing Address - Street 2:
Mailing Address - City:BUNKER HILL
Mailing Address - State:IL
Mailing Address - Zip Code:62014-0422
Mailing Address - Country:US
Mailing Address - Phone:618-585-6920
Mailing Address - Fax:618-585-6920
Practice Address - Street 1:120 WEST ALTON STREET
Practice Address - Street 2:
Practice Address - City:BUNKER HILL
Practice Address - State:IL
Practice Address - Zip Code:62014
Practice Address - Country:US
Practice Address - Phone:618-585-6920
Practice Address - Fax:618-585-6920
Is Sole Proprietor?:Yes
Enumeration Date:2008-12-12
Last Update Date:2008-12-12
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IL227-005351225700000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225700000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersMassage Therapist