Provider Demographics
NPI:1225272917
Name:SCHMOLZE, GINA MARIE (LPN)
Entity Type:Individual
Prefix:MS
First Name:GINA
Middle Name:MARIE
Last Name:SCHMOLZE
Suffix:
Gender:F
Credentials:LPN
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:PO BOX 97
Mailing Address - Street 2:
Mailing Address - City:SAINT GERMAIN
Mailing Address - State:WI
Mailing Address - Zip Code:54558-0097
Mailing Address - Country:US
Mailing Address - Phone:715-360-4773
Mailing Address - Fax:
Practice Address - Street 1:1567 GOLDEN RETREAT DR
Practice Address - Street 2:
Practice Address - City:SAINT GERMAIN
Practice Address - State:WI
Practice Address - Zip Code:54558-0097
Practice Address - Country:US
Practice Address - Phone:715-360-4773
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2009-04-24
Last Update Date:2009-04-24
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WI305115-31164W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes164W00000XNursing Service ProvidersLicensed Practical Nurse