Provider Demographics
NPI:1396330577
Name:CARRERO, KRISTINA (LPN)
Entity type:Individual
Prefix:
First Name:KRISTINA
Middle Name:
Last Name:CARRERO
Suffix:
Gender:F
Credentials:LPN
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:732 W PACKARD ST
Mailing Address - Street 2:
Mailing Address - City:APPLETON
Mailing Address - State:WI
Mailing Address - Zip Code:54914-3850
Mailing Address - Country:US
Mailing Address - Phone:920-558-1333
Mailing Address - Fax:
Practice Address - Street 1:813 S GOLDENROD DR
Practice Address - Street 2:
Practice Address - City:APPLETON
Practice Address - State:WI
Practice Address - Zip Code:54914-9696
Practice Address - Country:US
Practice Address - Phone:920-858-8172
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2021-03-09
Last Update Date:2021-03-09
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WI323620164W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes164W00000XNursing Service ProvidersLicensed Practical Nurse