Healthcare Provider Details

I. General information

NPI: 1902068422
Provider Name (Legal Business Name): KRISTINA O. SCHAUS MD
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

Provider Other Name: KRISTINA MARIE O'NEILL

II. Dates (important events)

Enumeration Date: 06/26/2008
Last Update Date: 06/30/2009
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1900 CENTRA CARE CIRCLE CENTRACARE CLINIC - WOMEN'S & CHILDRENS
ST CLOUD MN
56303-5000
US

IV. Provider business mailing address

1900 CENTRA CARE CIRCLE CENTRACARE CLINIC - WOMEN'S & CHILDRENS
ST CLOUD MN
56303-5000
US

V. Phone/Fax

Practice location:
  • Phone: 320-654-3630
  • Fax:
Mailing address:
  • Phone: 320-654-3630
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code208000000X
TaxonomyPediatrics Physician
License Number51785
License Number StateMN

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: