Provider Demographics
NPI:1821618083
Name:SCHNAKENBURG, ALEXIS LILLIAN
Entity Type:Individual
Prefix:
First Name:ALEXIS
Middle Name:LILLIAN
Last Name:SCHNAKENBURG
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 1:720 S WELLS ST APT 2108
Mailing Address - Street 2:
Mailing Address - City:CHICAGO
Mailing Address - State:IL
Mailing Address - Zip Code:60607-4794
Mailing Address - Country:US
Mailing Address - Phone:832-433-8645
Mailing Address - Fax:
Practice Address - Street 1:720 S WELLS ST APT 2108
Practice Address - Street 2:
Practice Address - City:CHICAGO
Practice Address - State:IL
Practice Address - Zip Code:60607-4794
Practice Address - Country:US
Practice Address - Phone:832-433-8645
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2020-04-17
Last Update Date:2020-04-17
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes390200000XStudent, Health CareStudent in an Organized Health Care Education/Training Program