Provider Demographics
NPI:1710687744
Name:SCHAFER, KRISTINA L (RN, LMT)
Entity Type:Individual
Prefix:
First Name:KRISTINA
Middle Name:L
Last Name:SCHAFER
Suffix:
Gender:F
Credentials:RN, LMT
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1905 W JOURDAN ST
Mailing Address - Street 2:
Mailing Address - City:NEWTON
Mailing Address - State:IL
Mailing Address - Zip Code:62448-2025
Mailing Address - Country:US
Mailing Address - Phone:618-783-2424
Mailing Address - Fax:618-783-8457
Practice Address - Street 1:1905 W JOURDAN ST
Practice Address - Street 2:
Practice Address - City:NEWTON
Practice Address - State:IL
Practice Address - Zip Code:62448-2025
Practice Address - Country:US
Practice Address - Phone:618-783-2424
Practice Address - Fax:618-783-8457
Is Sole Proprietor?:No
Enumeration Date:2023-03-08
Last Update Date:2023-03-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IL041.299268163W00000X
IL227.000999225700000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes163W00000XNursing Service ProvidersRegistered Nurse
No225700000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersMassage Therapist