Provider Demographics
NPI:1003166208
Name:SCHAEFER, SUSAN M (LPN)
Entity Type:Individual
Prefix:
First Name:SUSAN
Middle Name:M
Last Name:SCHAEFER
Suffix:
Gender:F
Credentials:LPN
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:13050 W BLUEMOUND RD
Mailing Address - Street 2:#207
Mailing Address - City:ELM GROVE
Mailing Address - State:WI
Mailing Address - Zip Code:53122-2661
Mailing Address - Country:US
Mailing Address - Phone:619-770-0331
Mailing Address - Fax:
Practice Address - Street 1:13050 W BLUEMOUND RD
Practice Address - Street 2:#207
Practice Address - City:ELM GROVE
Practice Address - State:WI
Practice Address - Zip Code:53122-2661
Practice Address - Country:US
Practice Address - Phone:619-770-0331
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2012-09-14
Last Update Date:2012-09-14
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WI19011-31164W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes164W00000XNursing Service ProvidersLicensed Practical Nurse