Provider Demographics
NPI:1093973539
Name:SCHAUT, SUSAN CAROL (LPN,RCS)
Entity Type:Individual
Prefix:MRS
First Name:SUSAN
Middle Name:CAROL
Last Name:SCHAUT
Suffix:
Gender:F
Credentials:LPN,RCS
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:207 CARVER ST
Mailing Address - Street 2:
Mailing Address - City:MOUNT HOREB
Mailing Address - State:WI
Mailing Address - Zip Code:53572-2184
Mailing Address - Country:US
Mailing Address - Phone:608-437-2202
Mailing Address - Fax:
Practice Address - Street 1:207 CARVER ST
Practice Address - Street 2:
Practice Address - City:MOUNT HOREB
Practice Address - State:WI
Practice Address - Zip Code:53572-2184
Practice Address - Country:US
Practice Address - Phone:608-437-2202
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2008-05-31
Last Update Date:2008-05-31
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WI28582031164W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes164W00000XNursing Service ProvidersLicensed Practical Nurse
Provider Identifiers
StateIdentifier IDID TypeIssuer
WI39936200Medicaid