Provider Demographics
NPI:1376540864
Name:SCHLOMER, MICHELLE RAE (MSN, APNP)
Entity Type:Individual
Prefix:
First Name:MICHELLE
Middle Name:RAE
Last Name:SCHLOMER
Suffix:
Gender:F
Credentials:MSN, APNP
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:W380N6009 HIGHWAY 67
Mailing Address - Street 2:
Mailing Address - City:OCONOMOWOC
Mailing Address - State:WI
Mailing Address - Zip Code:53066-1634
Mailing Address - Country:US
Mailing Address - Phone:262-560-4823
Mailing Address - Fax:
Practice Address - Street 1:1185 CORPORATE CENTER DR
Practice Address - Street 2:SUITE 175 PROHEALTH CARE MEDICAL ASSOCIATES INC
Practice Address - City:WAUKESHA
Practice Address - State:WI
Practice Address - Zip Code:53188-5031
Practice Address - Country:US
Practice Address - Phone:262-928-8400
Practice Address - Fax:262-928-8484
Is Sole Proprietor?:No
Enumeration Date:2005-06-30
Last Update Date:2012-04-03
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WI1056-033363LA2200X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LA2200XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerAdult Health
Provider Identifiers
StateIdentifier IDID TypeIssuer
WIS54766Medicare UPIN
683750668Medicare PIN