Healthcare Provider Details

I. General information

NPI: 1407201502
Provider Name (Legal Business Name): WENDIE SCHOEB MS, ATC, LAT
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 04/27/2016
Last Update Date: 07/19/2019
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

707 S UNIVERSITY AVE
BEAVER DAM WI
53916-3027
US

IV. Provider business mailing address

707 S UNIVERSITY AVE
BEAVER DAM WI
53916-3027
US

V. Phone/Fax

Practice location:
  • Phone: 507-412-9401
  • Fax:
Mailing address:
  • Phone: 507-412-9401
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code261QS1000X
TaxonomyStudent Health Clinic/Center
License Number1343
License Number StateMN
# 2
Primary TaxonomyN
Taxonomy Code146N00000X
TaxonomyBasic Emergency Medical Technician
License Number513235
License Number StateMN

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: