Provider Demographics
NPI:1821536616
Name:SCHWAPPACH, SUZANNE
Entity Type:Individual
Prefix:
First Name:SUZANNE
Middle Name:
Last Name:SCHWAPPACH
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 1:7084 100TH AVE SE
Mailing Address - Street 2:
Mailing Address - City:CLEAR LAKE
Mailing Address - State:MN
Mailing Address - Zip Code:55319-9607
Mailing Address - Country:US
Mailing Address - Phone:320-267-6016
Mailing Address - Fax:
Practice Address - Street 1:7084 100TH AVE SE
Practice Address - Street 2:
Practice Address - City:CLEAR LAKE
Practice Address - State:MN
Practice Address - Zip Code:55319-9607
Practice Address - Country:US
Practice Address - Phone:320-267-6016
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2017-02-01
Last Update Date:2017-02-01
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MNL-34547-7164W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes164W00000XNursing Service ProvidersLicensed Practical Nurse