Provider Demographics
NPI:1114946548
Name:SCHWARTZ, PEGGY L (ANP,MSN)
Entity Type:Individual
Prefix:
First Name:PEGGY
Middle Name:L
Last Name:SCHWARTZ
Suffix:
Gender:F
Credentials:ANP,MSN
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1111 DELAFIELD ST STE 327
Mailing Address - Street 2:
Mailing Address - City:WAUKESHA
Mailing Address - State:WI
Mailing Address - Zip Code:53188-3417
Mailing Address - Country:US
Mailing Address - Phone:262-524-1024
Mailing Address - Fax:262-524-8767
Practice Address - Street 1:2301 SUN VALLEY DR STE 200
Practice Address - Street 2:
Practice Address - City:DELAFIELD
Practice Address - State:WI
Practice Address - Zip Code:53018-2318
Practice Address - Country:US
Practice Address - Phone:262-646-4162
Practice Address - Fax:262-646-2498
Is Sole Proprietor?:No
Enumeration Date:2006-07-18
Last Update Date:2007-12-26
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WI87375-030363L00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363L00000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse Practitioner
Provider Identifiers
StateIdentifier IDID TypeIssuer
WI43928500Medicaid
WI43928500Medicaid
WIP15481Medicare UPIN