Healthcare Provider Details

I. General information

NPI: 1093786295
Provider Name (Legal Business Name): KELLY SCHUESSLER
Entity Type: Individual
Gender: Female
Sole Proprietor: X

II. Dates (important events)

Enumeration Date: 01/27/2006
Last Update Date: 07/08/2007
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

595 COUNTY TRUNK R
DENMARK WI
54208
US

IV. Provider business mailing address

1376 S OVERLAND RD
DE PERE WI
54115-9006
US

V. Phone/Fax

Practice location:
  • Phone: 920-863-5800
  • Fax:
Mailing address:
  • Phone:
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code183500000X
TaxonomyPharmacist
License Number12341
License Number StateWI

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: