Healthcare Provider Details

I. General information

NPI: 1689884124
Provider Name (Legal Business Name): WILLIAM RICHARD SCHOBERG RN
Entity Type: Individual
Gender: Male
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 05/23/2007
Last Update Date: 11/14/2016
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

2825 1ST AVE S
MINNEAPOLIS MN
55408-2351
US

IV. Provider business mailing address

2825 1ST AVE S
MINNEAPOLIS MN
55408-2351
US

V. Phone/Fax

Practice location:
  • Phone: 612-874-7628
  • Fax:
Mailing address:
  • Phone: 612-874-7628
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code163WG0000X
TaxonomyGeneral Practice Registered Nurse
License NumberR106736-9
License Number StateMN

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: