MEDICARE: TASHA SCHULKE RN

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	163WG0600X	Gerontology Registered Nurse	251507-30	WI

General Provider Information

NPI Number	:	1073320149
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	TASHA SCHULKE RN

Provider Business Mailing Address
First Line	:	1518 WESTERN AVE
Second Line	:
City	:	GREEN BAY
State	:	WI
Zip	:	54303-2214
Country	:	US
Telephone Number	:	920-209-6676
Fax Number	:

Provider Business Practice Location Address
First Line	:	1518 WESTERN AVE
Second Line	:
City	:	GREEN BAY
State	:	WI
Zip	:	54303-2214
Country	:	US
Telephone Number	:	920-209-6676
Fax Number	:

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

Provider Enumeration Date	:	12/12/2024
Last Update Date	:	12/12/2024

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