Healthcare Provider Details

I. General information

NPI: 1104476621
Provider Name (Legal Business Name): KRISTEN LEANNE SCHEURICH CPNP
Entity Type: Individual
Gender: Female
Sole Proprietor: N

Provider Other Name: KRISTEN LEANNE GAUMER CPNP

II. Dates (important events)

Enumeration Date: 09/17/2019
Last Update Date: 07/29/2024
Certification Date: 07/29/2024
Deactivation Date:
Reactivation Date:

III. Provider practice location address

2316 SOUTH ST
LAFAYETTE IN
47904-2971
US

IV. Provider business mailing address

1716 HARTFORD ST
LAFAYETTE IN
47904-2138
US

V. Phone/Fax

Practice location:
  • Phone: 765-742-1567
  • Fax: 765-429-2700
Mailing address:
  • Phone: 765-742-1567
  • Fax: 765-429-2700

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code163WP0200X
TaxonomyPediatric Registered Nurse
License Number28237512A
License Number StateIN
# 2
Primary TaxonomyY
Taxonomy Code363LP0200X
TaxonomyPediatric Nurse Practitioner
License Number28237512A
License Number StateIN

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: