Healthcare Provider Details

I. General information

NPI: 1093784829
Provider Name (Legal Business Name): MARILYN LOUISE SCHOMBURG L.P.N.
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 03/15/2006
Last Update Date: 07/09/2007
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1034 MAIN ST
WEST PORTSMOUTH OH
45663-5954
US

IV. Provider business mailing address

1034 MAIN ST
WEST PORTSMOUTH OH
45663-5954
US

V. Phone/Fax

Practice location:
  • Phone: 740-858-6361
  • Fax: 740-858-6361
Mailing address:
  • Phone: 740-858-6361
  • Fax: 740-858-6361

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code164W00000X
TaxonomyLicensed Practical Nurse
License NumberPN040373
License Number StateOH

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: