Provider Demographics
NPI:1699006320
Name:SCHNELLBACHER, CHARLOTTE (DO)
Entity Type:Individual
Prefix:
First Name:CHARLOTTE
Middle Name:
Last Name:SCHNELLBACHER
Suffix:
Gender:F
Credentials:DO
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:MADIGAN ARMY MEDICAL CENTER PEDIATRIC CLINIC
Mailing Address - Street 2:BLDG 9040 FITZSIMMONS DR
Mailing Address - City:TACOMA
Mailing Address - State:WA
Mailing Address - Zip Code:98431-0001
Mailing Address - Country:US
Mailing Address - Phone:253-968-3066
Mailing Address - Fax:
Practice Address - Street 1:MADIGAN ARMY MEDICAL CENTER PEDIATRIC CLINIC
Practice Address - Street 2:BLDG 9040 FITZSIMMONS DR
Practice Address - City:TACOMA
Practice Address - State:WA
Practice Address - Zip Code:98431-0001
Practice Address - Country:US
Practice Address - Phone:253-968-3066
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2010-01-20
Last Update Date:2012-08-09
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TN2109208000000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes208000000XAllopathic & Osteopathic PhysiciansPediatrics