Provider Demographics
NPI:1740421668
Name:SCHENKENBERG, ADAM C (LPN)
Entity Type:Individual
Prefix:
First Name:ADAM
Middle Name:C
Last Name:SCHENKENBERG
Suffix:
Gender:M
Credentials:LPN
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 271
Mailing Address - Street 2:1634 BIGWOODS DR
Mailing Address - City:SAINT GERMAIN
Mailing Address - State:WI
Mailing Address - Zip Code:54558-0271
Mailing Address - Country:US
Mailing Address - Phone:
Mailing Address - Fax:
Practice Address - Street 1:1634 BIGWOODS DR
Practice Address - Street 2:
Practice Address - City:SAINT GERMAIN
Practice Address - State:WI
Practice Address - Zip Code:54558-0271
Practice Address - Country:US
Practice Address - Phone:715-891-1731
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2009-03-24
Last Update Date:2009-03-24
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WI311042-31164W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes164W00000XNursing Service ProvidersLicensed Practical Nurse