1255508255 NPI number — MRS. LORI A SCHUMANN PT

Table of content: MRS. LORI A SCHUMANN PT (NPI 1255508255)

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1255508255 NPI number — MRS. LORI A SCHUMANN PT

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
Provider Last Name:
SCHUMANN
Provider First Name:
LORI
Provider Middle Name:
A
Provider Name Prefix Text:
MRS.
Provider Name Suffix Text:
Provider Credential Text:
PT
Provider Gender Code:
F

Provider's Other Name Information

Provider Other Organization Name:
Provider Other Organization Name Type Code:
Provider Other Last Name:
NASHOLD
Provider Other First Name:
LORI
Provider Other Middle Name:
A
Provider Other Name Prefix Text:
MS.
Provider Other Name Suffix Text:
Provider Other Credential Text:
PT
Provider Other Last Name Type Code:
2

NPI Number Information

NPI Number:
1255508255
Entity Type Code:
Individual
Replacement NPI:
Last Update Date:
05/09/2008
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
PO BOX 387
Provider Second Line Business Mailing Address:
2817 NEW PINERY ROAD
Provider Business Mailing Address City Name:
PORTAGE
Provider Business Mailing Address State Name:
WI
Provider Business Mailing Address Postal Code:
53901-0387
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
608-745-5063
Provider Business Mailing Address Fax Number:
608-745-6250

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
2817 NEW PINERY ROAD
Provider Second Line Business Practice Location Address:
DIVINE SAVIOR HEALTHCARE
Provider Business Practice Location Address City Name:
PORTAGE
Provider Business Practice Location Address State Name:
WI
Provider Business Practice Location Address Postal Code:
53901-0387
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
608-745-5063
Provider Business Practice Location Address Fax Number:
608-745-6250
Provider Enumeration Date:
05/09/2008

Additional Information

Authorized Official

Authorized Official Last Name:
Authorized Official First Name:
Authorized Official Middle Name:
Authorized Official Title or Position:
Authorized Official Telephone Number:

Provider Taxonomy Codes

  • Taxonomy code: 225100000X , with the licence number:  3177-024 , registered in the state of WI ; information, associated with the NPI states the following Primary Taxonomy Switch: "Y" .

Other Provider's Identifiers (legacy, non-NPI)

  • Identifier: 40111800 , issued by the state of ( WI ) . This identifiers is of the category "MEDICAID".




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