Provider Demographics
NPI:1558757468
Name:SCHUETTE, DAWN
Entity Type:Individual
Prefix:
First Name:DAWN
Middle Name:
Last Name:SCHUETTE
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:PO BOX 1027
Mailing Address - Street 2:
Mailing Address - City:JEFFERSON CITY
Mailing Address - State:MO
Mailing Address - Zip Code:65102-1027
Mailing Address - Country:US
Mailing Address - Phone:573-681-3767
Mailing Address - Fax:573-761-6947
Practice Address - Street 1:3626 S CLARK ST
Practice Address - Street 2:SUITE C
Practice Address - City:MEXICO
Practice Address - State:MO
Practice Address - Zip Code:65265-4104
Practice Address - Country:US
Practice Address - Phone:573-582-0850
Practice Address - Fax:573-582-0854
Is Sole Proprietor?:No
Enumeration Date:2015-04-08
Last Update Date:2024-01-05
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MO2015006321363LF0000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LF0000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerFamily
Provider Identifiers
StateIdentifier IDID TypeIssuer
MO1558757468Medicaid
MO118080039Medicare PIN