Provider Demographics
NPI:1407474463
Name:SCHULENBERG, MADISON NICOLE (PA-C)
Entity Type:Individual
Prefix:
First Name:MADISON
Middle Name:NICOLE
Last Name:SCHULENBERG
Suffix:
Gender:F
Credentials:PA-C
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1111 W 14TH PL UNIT 119
Mailing Address - Street 2:
Mailing Address - City:CHICAGO
Mailing Address - State:IL
Mailing Address - Zip Code:60608-2796
Mailing Address - Country:US
Mailing Address - Phone:309-798-1682
Mailing Address - Fax:
Practice Address - Street 1:1111 W 14TH PL UNIT 119
Practice Address - Street 2:
Practice Address - City:CHICAGO
Practice Address - State:IL
Practice Address - Zip Code:60608-2796
Practice Address - Country:US
Practice Address - Phone:309-798-1682
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2020-07-07
Last Update Date:2023-07-27
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IL085008444363A00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363A00000XPhysician Assistants & Advanced Practice Nursing ProvidersPhysician Assistant