Provider Demographics
NPI:1215415799
Name:SCHMULBACH, BREE
Entity Type:Individual
Prefix:
First Name:BREE
Middle Name:
Last Name:SCHMULBACH
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:125 E PLUMMER BLVD STE A
Mailing Address - Street 2:
Mailing Address - City:CHATHAM
Mailing Address - State:IL
Mailing Address - Zip Code:62629-8136
Mailing Address - Country:US
Mailing Address - Phone:217-483-3333
Mailing Address - Fax:217-483-4393
Practice Address - Street 1:125 E PLUMMER BLVD
Practice Address - Street 2:
Practice Address - City:CHATHAM
Practice Address - State:IL
Practice Address - Zip Code:62629-8134
Practice Address - Country:US
Practice Address - Phone:217-483-3333
Practice Address - Fax:217-483-4393
Is Sole Proprietor?:No
Enumeration Date:2018-08-06
Last Update Date:2022-04-06
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IL209017873363L00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363L00000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse Practitioner