Provider Demographics
NPI:1083880314
Name:SCHNEIDER, VICTORIA LYNN (RN)
Entity Type:Individual
Prefix:
First Name:VICTORIA
Middle Name:LYNN
Last Name:SCHNEIDER
Suffix:
Gender:F
Credentials:RN
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:200 S MAIN ST
Mailing Address - Street 2:
Mailing Address - City:CEDAR GROVE
Mailing Address - State:WI
Mailing Address - Zip Code:53013-1305
Mailing Address - Country:US
Mailing Address - Phone:920-668-6425
Mailing Address - Fax:
Practice Address - Street 1:200 S MAIN ST
Practice Address - Street 2:
Practice Address - City:CEDAR GROVE
Practice Address - State:WI
Practice Address - Zip Code:53013-1305
Practice Address - Country:US
Practice Address - Phone:920-668-6425
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2008-05-06
Last Update Date:2008-05-06
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WI63611-030163WG0000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes163WG0000XNursing Service ProvidersRegistered NurseGeneral Practice
Provider Identifiers
StateIdentifier IDID TypeIssuer
WI38329600Medicaid