Provider Demographics
NPI:1255576849
Name:SCHULZE, CHRYSTAL MARIE
Entity type:Individual
Prefix:MRS
First Name:CHRYSTAL
Middle Name:MARIE
Last Name:SCHULZE
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:W6827 N EASTWOOD ST
Mailing Address - Street 2:
Mailing Address - City:VAN DYNE
Mailing Address - State:WI
Mailing Address - Zip Code:54979
Mailing Address - Country:US
Mailing Address - Phone:920-688-2249
Mailing Address - Fax:
Practice Address - Street 1:W6827 N EASTWOOD ST
Practice Address - Street 2:
Practice Address - City:VAN DYNE
Practice Address - State:WI
Practice Address - Zip Code:54979
Practice Address - Country:US
Practice Address - Phone:920-688-2249
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2008-12-10
Last Update Date:2008-12-10
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WI304249031164W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes164W00000XNursing Service ProvidersLicensed Practical Nurse