Healthcare Provider Details

I. General information

NPI: 1730630740
Provider Name (Legal Business Name): KRISTA K SCHULTE
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 10/14/2016
Last Update Date: 08/11/2020
Certification Date: 08/11/2020
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1000 N ALLEN ST
ROBINSON IL
62454-1114
US

IV. Provider business mailing address

1000 N ALLEN ST
ROBINSON IL
62454-1114
US

V. Phone/Fax

Practice location:
  • Phone: 618-544-3131
  • Fax: 618-546-2686
Mailing address:
  • Phone: 618-544-3131
  • Fax: 618-546-2686

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code363LF0000X
TaxonomyFamily Nurse Practitioner
License Number209019100
License Number StateIL

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: