Provider Demographics
NPI:1013219567
Name:SCHMUDLACH, TAMI MAE (RN)
Entity Type:Individual
Prefix:MS
First Name:TAMI
Middle Name:MAE
Last Name:SCHMUDLACH
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 1:5164 ANTON DR APT 105
Mailing Address - Street 2:
Mailing Address - City:FITCHBURG
Mailing Address - State:WI
Mailing Address - Zip Code:53719-1707
Mailing Address - Country:US
Mailing Address - Phone:608-577-5960
Mailing Address - Fax:
Practice Address - Street 1:5164 ANTON DR APT 105
Practice Address - Street 2:
Practice Address - City:FITCHBURG
Practice Address - State:WI
Practice Address - Zip Code:53719-1707
Practice Address - Country:US
Practice Address - Phone:608-577-5960
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2010-12-02
Last Update Date:2010-12-02
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WI172645-030163WH0200X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes163WH0200XNursing Service ProvidersRegistered NurseHome Health