Provider Demographics
NPI:1932469665
Name:SCHMIDT-STUCKE, DEBRA S (RN)
Entity Type:Individual
Prefix:
First Name:DEBRA
Middle Name:S
Last Name:SCHMIDT-STUCKE
Suffix:
Gender:F
Credentials:RN
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:N2209 COUNTY ROAD K
Mailing Address - Street 2:
Mailing Address - City:CAMPBELLSPORT
Mailing Address - State:WI
Mailing Address - Zip Code:53010-1538
Mailing Address - Country:US
Mailing Address - Phone:920-979-0003
Mailing Address - Fax:
Practice Address - Street 1:N2209 CTY RD K
Practice Address - Street 2:
Practice Address - City:CAMPBELLSPORT
Practice Address - State:WI
Practice Address - Zip Code:53030-1538
Practice Address - Country:US
Practice Address - Phone:920-979-0002
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2012-05-29
Last Update Date:2012-05-29
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WI105479-030163W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes163W00000XNursing Service ProvidersRegistered Nurse