Healthcare Provider Details

I. General information

NPI: 1699212399
Provider Name (Legal Business Name): URSULA SCHMIEL-DEGAMA LPN
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 01/19/2017
Last Update Date: 01/19/2017
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

11900 NW 35TH ST
SUNRISE FL
33323-1242
US

IV. Provider business mailing address

11900 NW 35TH ST
SUNRISE FL
33323-1242
US

V. Phone/Fax

Practice location:
  • Phone: 954-639-3611
  • Fax: 954-746-2544
Mailing address:
  • Phone: 954-639-3611
  • Fax: 954-746-2544

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code376G00000X
TaxonomyNursing Home Administrator
License NumberAL12946
License Number StateFL

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: