Healthcare Provider Details

I. General information

NPI: 1457386906
Provider Name (Legal Business Name): MICHELE SCHOENBORN NP
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 07/12/2006
Last Update Date: 07/22/2022
Certification Date: 07/22/2022
Deactivation Date:
Reactivation Date:

III. Provider practice location address

164 W 13TH ST
GRAFTON ND
58237-1826
US

IV. Provider business mailing address

1877 230TH AVE
MAHNOMEN MN
56557-9059
US

V. Phone/Fax

Practice location:
  • Phone: 701-352-1620
  • Fax:
Mailing address:
  • Phone: 763-213-2030
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code363L00000X
TaxonomyNurse Practitioner
License NumberR1386972
License Number StateMN

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: