Provider Demographics
NPI:1942300066
Name:SCHAUMBERG, LAURIE L (RN, APNP)
Entity Type:Individual
Prefix:
First Name:LAURIE
Middle Name:L
Last Name:SCHAUMBERG
Suffix:
Gender:F
Credentials:RN, APNP
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:3150 GERSHWIN DRIVE
Mailing Address - Street 2:
Mailing Address - City:GREEN BAY
Mailing Address - State:WI
Mailing Address - Zip Code:54311-5859
Mailing Address - Country:US
Mailing Address - Phone:920-391-6940
Mailing Address - Fax:920-391-4811
Practice Address - Street 1:3150 GERSHWIN DRIVE
Practice Address - Street 2:
Practice Address - City:GREEN BAY
Practice Address - State:WI
Practice Address - Zip Code:54311-5859
Practice Address - Country:US
Practice Address - Phone:920-391-6940
Practice Address - Fax:920-391-4811
Is Sole Proprietor?:No
Enumeration Date:2006-09-25
Last Update Date:2009-11-12
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WI229363L00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363L00000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse Practitioner
Provider Identifiers
StateIdentifier IDID TypeIssuer
WI39403400Medicaid
WI39403400Medicaid