Provider Demographics
NPI:1467820464
Name:SCHRAB, JAMMIE
Entity Type:Individual
Prefix:
First Name:JAMMIE
Middle Name:
Last Name:SCHRAB
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:JAMMIE
Other - Middle Name:
Other - Last Name:WAFLE
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:RD, CD
Mailing Address - Street 1:N69W6855 BRIDGE RD
Mailing Address - Street 2:UNIT #2
Mailing Address - City:CEDARBURG
Mailing Address - State:WI
Mailing Address - Zip Code:53012-1869
Mailing Address - Country:US
Mailing Address - Phone:414-688-7282
Mailing Address - Fax:
Practice Address - Street 1:1220 DEWEY AVE
Practice Address - Street 2:
Practice Address - City:MILWAUKEE
Practice Address - State:WI
Practice Address - Zip Code:53213-2504
Practice Address - Country:US
Practice Address - Phone:414-464-6683
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2015-09-08
Last Update Date:2015-09-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WI2772133V00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes133V00000XDietary & Nutritional Service ProvidersDietitian, Registered