Provider Demographics
NPI:1407961493
Name:SCHREINER, LOIS L (PA - C)
Entity Type:Individual
Prefix:
First Name:LOIS
Middle Name:L
Last Name:SCHREINER
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 1:1132 SE CATALPA RD
Mailing Address - Street 2:
Mailing Address - City:SHARON
Mailing Address - State:KS
Mailing Address - Zip Code:67138-9055
Mailing Address - Country:US
Mailing Address - Phone:620-294-5521
Mailing Address - Fax:
Practice Address - Street 1:710 N WALNUT ST
Practice Address - Street 2:
Practice Address - City:MEDICINE LODGE
Practice Address - State:KS
Practice Address - Zip Code:67104-1019
Practice Address - Country:US
Practice Address - Phone:620-886-5653
Practice Address - Fax:620-886-5315
Is Sole Proprietor?:No
Enumeration Date:2006-08-20
Last Update Date:2007-07-09
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
KS1501099363AM0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363AM0700XPhysician Assistants & Advanced Practice Nursing ProvidersPhysician AssistantMedical
Provider Identifiers
StateIdentifier IDID TypeIssuer
Q51613Medicare UPIN
KS426895Medicare ID - Type UnspecifiedCLINIC PROVIDER BILLING #