MEDICARE: CHERYL KANDLER-KRUTINA 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	163W00000X	Registered Nurse	168465-30	WI
2	171M00000X	Case Manager/Care Coordinator	168465-30	WI
3	3747P1801X	Personal Care Attendant	168465-30	WI

General Provider Information

NPI Number	:	1538872189
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	CHERYL KANDLER-KRUTINA RN

Provider Business Mailing Address
First Line	:	7831 W TESCH AVE
Second Line	:
City	:	MILWAUKEE
State	:	WI
Zip	:	53220-2216
Country	:	US
Telephone Number	:	262-623-4406
Fax Number	:

Provider Business Practice Location Address
First Line	:	7831 W TESCH AVE
Second Line	:
City	:	MILWAUKEE
State	:	WI
Zip	:	53220-2216
Country	:	US
Telephone Number	:	262-623-4406
Fax Number	:

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

Provider Enumeration Date	:	12/28/2022
Last Update Date	:	05/06/2025

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