1922287200 NPI number — MRS. NANCY JEAN SCHUMITSCH RD CD CDE

Table of content: MRS. NANCY JEAN SCHUMITSCH RD CD CDE (NPI 1922287200)

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1922287200 NPI number — MRS. NANCY JEAN SCHUMITSCH RD CD CDE

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
Provider Last Name:
SCHUMITSCH
Provider First Name:
NANCY
Provider Middle Name:
JEAN
Provider Name Prefix Text:
MRS.
Provider Name Suffix Text:
Provider Credential Text:
RD CD CDE
Provider Gender Code:
F

Provider's Other Name Information

Provider Other Organization Name:
Provider Other Organization Name Type Code:
Provider Other Last Name:
Provider Other First Name:
Provider Other Middle Name:
Provider Other Name Prefix Text:
Provider Other Name Suffix Text:
Provider Other Credential Text:
Provider Other Last Name Type Code:

NPI Number Information

NPI Number:
1922287200
Entity Type Code:
Individual
Replacement NPI:
Last Update Date:
11/05/2007
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
704 SOUTH WEBSTER AVE
Provider Second Line Business Mailing Address:
SUITE 500
Provider Business Mailing Address City Name:
GREEN BAY
Provider Business Mailing Address State Name:
WI
Provider Business Mailing Address Postal Code:
54301
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
920-468-9588
Provider Business Mailing Address Fax Number:
920-468-1342

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
704 SOUTH WEBSTER AVE
Provider Second Line Business Practice Location Address:
SUITE 500
Provider Business Practice Location Address City Name:
GREEN BAY
Provider Business Practice Location Address State Name:
WI
Provider Business Practice Location Address Postal Code:
54301
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
920-468-9588
Provider Business Practice Location Address Fax Number:
920-468-1342
Provider Enumeration Date:
11/02/2007

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: 133V00000X , with the licence number:  875238 ; information, associated with the NPI states the following Primary Taxonomy Switch: "Y" .
  • Taxonomy code: 133V00000X , with the licence number: 1523029 , registered in the state of WI ; information, associated with the NPI states the following Primary Taxonomy Switch: "N" .

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





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