Healthcare Provider Details

I. General information

NPI: 1215415799
Provider Name (Legal Business Name): BREE A SCHMULBACH APN
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 08/06/2018
Last Update Date: 10/25/2024
Certification Date: 10/22/2024
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1 CENTRE DRIVE
PETERSBURG IL
62675-9467
US

IV. Provider business mailing address

1 CENTRE DRIVE
PETERSBURG IL
62675-9467
US

V. Phone/Fax

Practice location:
  • Phone: 217-632-7761
  • Fax: 217-632-0312
Mailing address:
  • Phone: 217-632-7761
  • Fax: 217-632-0312

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code363LF0000X
TaxonomyFamily Nurse Practitioner
License Number209017873
License Number StateIL

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: