Provider Demographics
NPI:1518492735
Name:SCHUERGER, MICKIE DIANA (FNP)
Entity Type:Individual
Prefix:
First Name:MICKIE
Middle Name:DIANA
Last Name:SCHUERGER
Suffix:
Gender:F
Credentials:FNP
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:107 BELMONT AVE
Mailing Address - Street 2:# 3
Mailing Address - City:LONG BEACH
Mailing Address - State:CA
Mailing Address - Zip Code:90803-2929
Mailing Address - Country:US
Mailing Address - Phone:310-802-9410
Mailing Address - Fax:
Practice Address - Street 1:1113 ALTA AVE
Practice Address - Street 2:SUITE 220
Practice Address - City:UPLAND
Practice Address - State:CA
Practice Address - Zip Code:91786-2800
Practice Address - Country:US
Practice Address - Phone:909-985-1908
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2017-04-25
Last Update Date:2017-04-25
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA95006036363LF0000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LF0000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerFamily