Provider Demographics
NPI:1093706616
Name:SCHAEFER, MARY K (PA-C)
Entity Type:Individual
Prefix:
First Name:MARY
Middle Name:K
Last Name:SCHAEFER
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 1:401 W GLYNN DR
Mailing Address - Street 2:
Mailing Address - City:PARKSTON
Mailing Address - State:SD
Mailing Address - Zip Code:57366-9605
Mailing Address - Country:US
Mailing Address - Phone:605-928-7961
Mailing Address - Fax:605-928-7368
Practice Address - Street 1:401 W GLYNN DR
Practice Address - Street 2:
Practice Address - City:PARKSTON
Practice Address - State:SD
Practice Address - Zip Code:57366-9605
Practice Address - Country:US
Practice Address - Phone:605-928-7961
Practice Address - Fax:605-928-7368
Is Sole Proprietor?:No
Enumeration Date:2005-11-02
Last Update Date:2012-08-09
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
SD0388363A00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363A00000XPhysician Assistants & Advanced Practice Nursing ProvidersPhysician Assistant
Provider Identifiers
StateIdentifier IDID TypeIssuer
SD0007354OtherWELLMARK PARKSTON
SD4997644OtherWELLMARK - LAKE ANDES
SD4997652OtherWELLMARK - TRIPP
SD5340340Medicaid
SD9247664OtherDAKOTACARE
SD5340070Medicaid
SD6821750Medicaid
SD4997644OtherWELLMARK - LAKE ANDES
SD9247664OtherDAKOTACARE
SD6821750Medicaid
SD970015370Medicare PIN