Basic Information
| Provider Information | |||||||||
| NPI: | 1275162851 | ||||||||
| EntityType: | 1 | ||||||||
| ReplacementNPI: | |||||||||
| OrganizationName: | |||||||||
| LastName: | SCHAFF | ||||||||
| FirstName: | KIMBERLY | ||||||||
| MiddleName: | ANN | ||||||||
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| Credential: | RN | ||||||||
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| Mailing Information | |||||||||
| Address1: | 8625 W MITCHELL ST | ||||||||
| Address2: | |||||||||
| City: | WEST ALLIS | ||||||||
| State: | WI | ||||||||
| PostalCode: | 532144336 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 9202293570 | ||||||||
| FaxNumber: | |||||||||
| Practice Location | |||||||||
| Address1: | 4448 W LOOMIS RD | ||||||||
| Address2: | |||||||||
| City: | GREENFIELD | ||||||||
| State: | WI | ||||||||
| PostalCode: | 532204800 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 4142815150 | ||||||||
| FaxNumber: | |||||||||
| Other Information | |||||||||
| ProviderEnumerationDate: | 04/05/2020 | ||||||||
| LastUpdateDate: | 04/28/2020 | ||||||||
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| ProviderGenderCode: | F | ||||||||
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| IsSoleProprietor: | N | ||||||||
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| NPICertificationDate: | 04/28/2020 | ||||||||
Taxonomy Information
| Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 163W00000X | 199490 | WI | N | Nursing Service Providers | Registered Nurse | 163WD0400X | 199490 | WI | Y | Nursing Service Providers | Registered Nurse | Diabetes Educator |
No ID Information.