Healthcare Provider Details

I. General information

NPI: 1316202302
Provider Name (Legal Business Name): BRADLEIGH ROSE SCHAFER PA-C
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

Provider Other Name: BRADLEIGH ROSE ZITO PA-C

II. Dates (important events)

Enumeration Date: 07/06/2012
Last Update Date: 10/03/2025
Certification Date: 10/03/2025
Deactivation Date:
Reactivation Date:

III. Provider practice location address

5535 NOBEL DR
FITCHBURG WI
53711-4955
US

IV. Provider business mailing address

PO BOX 74008272
CHICAGO IL
60674-8272
US

V. Phone/Fax

Practice location:
  • Phone: 872-231-3162
  • Fax:
Mailing address:
  • Phone: 702-899-0595
  • Fax: 702-977-1496

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code363A00000X
TaxonomyPhysician Assistant
License Number22907
License Number StateCA
# 2
Primary TaxonomyY
Taxonomy Code363A00000X
TaxonomyPhysician Assistant
License Number352823
License Number StateWI
# 3
Primary TaxonomyN
Taxonomy Code363A00000X
TaxonomyPhysician Assistant
License NumberPA.1150
License Number StateAL
# 4
Primary TaxonomyN
Taxonomy Code363A00000X
TaxonomyPhysician Assistant
License Number0010-03629
License Number StateNC

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: