Healthcare Provider Details

I. General information

NPI: 1952519290
Provider Name (Legal Business Name): NANCY ANN DEXTER - SCHABOW MT-BC, WMTR
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 05/18/2007
Last Update Date: 07/08/2007
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1125 JAMES DR
HARTLAND WI
53029-8310
US

IV. Provider business mailing address

523 HARTRIDGE DR
HARTLAND WI
53029-2613
US

V. Phone/Fax

Practice location:
  • Phone: 262-367-6663
  • Fax: 262-367-3056
Mailing address:
  • Phone: 262-369-3977
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code225A00000X
TaxonomyMusic Therapist
License Number32-038
License Number StateWI

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: