Healthcare Provider Details

I. General information

NPI: 1194928580
Provider Name (Legal Business Name): LISA L. SCHRAMEK APN-BC, FPA
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 06/06/2007
Last Update Date: 04/05/2022
Certification Date: 04/05/2022
Deactivation Date:
Reactivation Date:

III. Provider practice location address

207 MATLOCK DR
SAINT JAMES MO
65559-1034
US

IV. Provider business mailing address

207 MATLOCK DR
SAINT JAMES MO
65559-1034
US

V. Phone/Fax

Practice location:
  • Phone: 573-265-4889
  • Fax: 573-265-0449
Mailing address:
  • Phone: 573-265-0448
  • Fax: 573-265-0449

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code363LA2200X
TaxonomyAdult Health Nurse Practitioner
License Number209005405
License Number StateIL
# 2
Primary TaxonomyY
Taxonomy Code363LP2300X
TaxonomyPrimary Care Nurse Practitioner
License Number277000331
License Number StateIL

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: