Provider Demographics
NPI:1083696512
Name:SCHWEITZER, SHEILA (PA C)
Entity Type:Individual
Prefix:
First Name:SHEILA
Middle Name:
Last Name:SCHWEITZER
Suffix:
Gender:F
Credentials:PA C
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:PO BOX 182
Mailing Address - Street 2:801 MAIN STREET
Mailing Address - City:TIMBER LAKE
Mailing Address - State:SD
Mailing Address - Zip Code:57656-0182
Mailing Address - Country:US
Mailing Address - Phone:605-865-3162
Mailing Address - Fax:
Practice Address - Street 1:801 MAIN ST
Practice Address - Street 2:
Practice Address - City:TIMBER LAKE
Practice Address - State:SD
Practice Address - Zip Code:57656-9998
Practice Address - Country:US
Practice Address - Phone:605-865-3162
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2005-11-18
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
SD0346363A00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363A00000XPhysician Assistants & Advanced Practice Nursing ProvidersPhysician Assistant
Provider Identifiers
StateIdentifier IDID TypeIssuer
S14974Medicare UPIN