Basic Information
Provider Information
NPI: 1497085542
EntityType: 1
ReplacementNPI:  
OrganizationName:  
LastName: SCHUELKE
FirstName: CAROL
MiddleName: ELIZABETH
NamePrefix: MRS.
NameSuffix:  
Credential: RT(R)
OtherOrganizationName:  
OtherOrganizationType:  
OtherLastName:  
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Mailing Information
Address1: P.O. BOX 209036
Address2: SHRINERS HOSPITALS FOR CHILDREN TWIN CITIES
City: DALLAS
State: TX
PostalCode: 753209036
CountryCode: US
TelephoneNumber: 8132818478
FaxNumber: 8132818113
Practice Location
Address1: 2025 EAST RIVER PARKWAY
Address2: SHRINER'S HOSPITAL FOR CHILDREN
City: MINNEAPOLIS
State: MN
PostalCode: 55414
CountryCode: US
TelephoneNumber: 6125966100
FaxNumber: 6125966153
Other Information
ProviderEnumerationDate: 01/12/2010
LastUpdateDate: 03/29/2011
NPIDeactivationReasonCode:  
NPIDeactivationDate:  
NPIReactivationDate:  
ProviderGenderCode: F
AuthorizedOfficialLastName:  
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AuthorizedOfficialTelephone:  
IsSoleProprietor: N
IsOrganizationSubpart:  
ParentOrganizationLBN:  
AuthorizedOfficialNamePrefix:  
AuthorizedOfficialNameSuffix:  
AuthorizedOfficialCredential:  
NPICertificationDate:  

Taxonomy Information
TaxonomyLicenseStateSwitchTaxonomyGroupTaxonomyTypeTaxonomyClassSubSpecialty
247100000X  Y Technologists, Technicians & Other Technical Service ProvidersRadiologic Technologist 

No ID Information.


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