Healthcare Provider Details

I. General information

NPI: 1265451264
Provider Name (Legal Business Name): JO ELLEN SCHAEFER NP
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

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

III. Provider practice location address

320 ROSS AVE STE 14
SCHOFIELD WI
54476-6104
US

IV. Provider business mailing address

4202 MOUNTAIN LN
WAUSAU WI
54401-8500
US

V. Phone/Fax

Practice location:
  • Phone: 715-359-8725
  • Fax:
Mailing address:
  • Phone: 715-848-8748
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code363LA2200X
TaxonomyAdult Health Nurse Practitioner
License Number740-033
License Number StateWI

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: