Healthcare Provider Details

I. General information

NPI: 1194830570
Provider Name (Legal Business Name): MARY JOAN SCHOENWETTER APNP
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 08/19/2006
Last Update Date: 07/08/2007
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

2500 OVERLOOK TERRACE WM. S. MIDDLETON MEMORIAL VETERANS HOSPITAL
MADISON WI
53705
US

IV. Provider business mailing address

652 SADDLE RDG
PORTAGE WI
53901-9701
US

V. Phone/Fax

Practice location:
  • Phone: 608-256-1901
  • Fax: 920-356-9477
Mailing address:
  • Phone: 608-742-1454
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code363LG0600X
TaxonomyGerontology Nurse Practitioner
License Number54553
License Number StateWI

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: