Healthcare Provider Details

I. General information

NPI: 1851118806
Provider Name (Legal Business Name): LIBBY SAMANTHA SCHOENBERG PA-S
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 09/23/2024
Last Update Date: 05/21/2026
Certification Date: 05/21/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

939 WILSON RD
EAST LANSING MI
48824-6410
US

IV. Provider business mailing address

3621 ROBINA AVE
BERKLEY MI
48072-1443
US

V. Phone/Fax

Practice location:
  • Phone: 248-504-1288
  • Fax:
Mailing address:
  • Phone: 248-504-1288
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code363AM0700X
TaxonomyMedical Physician Assistant
License Number1851118806
License Number StateMI

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: