Healthcare Provider Details

I. General information

NPI: 1447243597
Provider Name (Legal Business Name): MICHAEL WAYNE SCHUCKER PA-C
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 08/24/2005
Last Update Date: 07/03/2026
Certification Date: 07/03/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1610 E SCHNEIDMILLER AVE
POST FALLS ID
83854-7065
US

IV. Provider business mailing address

1610 E SCHNEIDMILLER AVE
POST FALLS ID
83854-7065
US

V. Phone/Fax

Practice location:
  • Phone: 208-618-6070
  • Fax: 208-618-8903
Mailing address:
  • Phone: 208-618-6070
  • Fax: 208-618-8903

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code363A00000X
TaxonomyPhysician Assistant
License Number9581201
License Number StateID
# 2
Primary TaxonomyN
Taxonomy Code363A00000X
TaxonomyPhysician Assistant
License NumberPA10004160
License Number StateWA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: