Provider Demographics
NPI:1093363657
Name:SCHWIESO, DEAN HARLEY I
Entity Type:Individual
Prefix:
First Name:DEAN
Middle Name:HARLEY
Last Name:SCHWIESO
Suffix:I
Gender:M
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:N5835 COUNTY RD N
Mailing Address - Street 2:
Mailing Address - City:JEFFERSON
Mailing Address - State:WI
Mailing Address - Zip Code:53549-9698
Mailing Address - Country:US
Mailing Address - Phone:608-509-3527
Mailing Address - Fax:
Practice Address - Street 1:N5835 COUNTY RD N
Practice Address - Street 2:
Practice Address - City:JEFFERSON
Practice Address - State:WI
Practice Address - Zip Code:53549-9698
Practice Address - Country:US
Practice Address - Phone:608-509-3527
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2019-08-27
Last Update Date:2019-08-27
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes310400000XNursing & Custodial Care FacilitiesAssisted Living Facility