Provider Demographics
NPI:1659323103
Name:SCHAEFER, CYRIL J (ARNP)
Entity Type:Individual
Prefix:
First Name:CYRIL
Middle Name:J
Last Name:SCHAEFER
Suffix:
Gender:M
Credentials:ARNP
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:401 W PENNSYLVANIA ST
Mailing Address - Street 2:
Mailing Address - City:ANACONDA
Mailing Address - State:MT
Mailing Address - Zip Code:59711-1931
Mailing Address - Country:US
Mailing Address - Phone:406-563-8686
Mailing Address - Fax:406-563-8691
Practice Address - Street 1:401 W PENNSYLVANIA ST
Practice Address - Street 2:
Practice Address - City:ANACONDA
Practice Address - State:MT
Practice Address - Zip Code:59711-1931
Practice Address - Country:US
Practice Address - Phone:406-563-8686
Practice Address - Fax:406-563-8691
Is Sole Proprietor?:No
Enumeration Date:2006-05-16
Last Update Date:2014-01-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MTRN21373363L00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363L00000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse Practitioner
Provider Identifiers
StateIdentifier IDID TypeIssuer
MT4305199Medicaid
Q30750Medicare UPIN
000084333Medicare ID - Type Unspecified