Healthcare Provider Details

I. General information

NPI: 1326376112
Provider Name (Legal Business Name): ALYSSA J SCHUMACHER BS, LRT
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 12/07/2009
Last Update Date: 12/07/2009
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

2800 CLEVELAND AVE N
ROSEVILLE MN
55113-1126
US

IV. Provider business mailing address

2800 CLEVELAND AVE N
ROSEVILLE MN
55113-1126
US

V. Phone/Fax

Practice location:
  • Phone: 651-642-1825
  • Fax:
Mailing address:
  • Phone:
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code2279P3900X
TaxonomyNeonatal/Pediatric Registered Respiratory Therapist
License Number3594
License Number StateMN

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: