MEDICARE: KIMBERLY DAWN SCHUELKE CNP

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	363LF0000X	Family Nurse Practitioner	R1673290	MN

General Provider Information

NPI Number	:	1093119653
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	KIMBERLY DAWN SCHUELKE CNP

Provider Business Mailing Address
First Line	:	1747 BEAM AVE
Second Line	:
City	:	MAPLEWOOD
State	:	MN
Zip	:	56435-1128
Country	:	US
Telephone Number	:	651-326-5444
Fax Number	:	651-326-5529

Provider Business Practice Location Address
First Line	:	1747 BEAM AVE
Second Line	:
City	:	MAPLEWOOD
State	:	MN
Zip	:	55109-1128
Country	:	US
Telephone Number	:	651-326-5444
Fax Number	:	651-326-5529

Authorized Official
Title or Position	:
Name	:
Credential	:
Telephone Number	:

Provider Enumeration Date	:	10/10/2014
Last Update Date	:	11/20/2023

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