MEDICARE: KRISTIN SHUTT 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	163WA0400X	Addiction (Substance Use Disorder) Registered Nurse	191473	WI

General Provider Information

NPI Number	:	1780513655
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	KRISTIN SHUTT RN

Provider Business Mailing Address
First Line	:	1518 W MASON ST
Second Line	:
City	:	GREEN BAY
State	:	WI
Zip	:	54303-2216
Country	:	US
Telephone Number	:	920-238-8599
Fax Number	:	920-238-8597

Provider Business Practice Location Address
First Line	:	1518 W MASON ST
Second Line	:
City	:	GREEN BAY
State	:	WI
Zip	:	54303-2216
Country	:	US
Telephone Number	:	920-238-8599
Fax Number	:	920-238-8597

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

Provider Enumeration Date	:	05/18/2026
Last Update Date	:	05/18/2026

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