Basic Information
| Provider Information | |||||||||
| NPI: | 1588155790 | ||||||||
| EntityType: | 1 | ||||||||
| ReplacementNPI: | |||||||||
| OrganizationName: | |||||||||
| LastName: | SCHUSTER | ||||||||
| FirstName: | KELLYN | ||||||||
| MiddleName: | |||||||||
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| Credential: | DSD LVN | ||||||||
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| Mailing Information | |||||||||
| Address1: | 1742 S GRAND ST | ||||||||
| Address2: | |||||||||
| City: | VISALIA | ||||||||
| State: | CA | ||||||||
| PostalCode: | 932924417 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 1559308515 | ||||||||
| FaxNumber: | |||||||||
| Practice Location | |||||||||
| Address1: | 2140 MERCED ST | ||||||||
| Address2: | |||||||||
| City: | FRESNO | ||||||||
| State: | CA | ||||||||
| PostalCode: | 937211721 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 5598921125 | ||||||||
| FaxNumber: | |||||||||
| Other Information | |||||||||
| ProviderEnumerationDate: | 05/23/2018 | ||||||||
| LastUpdateDate: | 05/23/2018 | ||||||||
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| ProviderGenderCode: | F | ||||||||
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| IsSoleProprietor: | N | ||||||||
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Taxonomy Information
| Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 164X00000X | 247536 | CA | Y | Nursing Service Providers | Licensed Vocational Nurse |
No ID Information.