=====================================================
General NPI Number Information
=====================================================
NPI Number | 1184059560
-----------------------------------------------------
Entity Type | Individual
-----------------------------------------------------
Provider Name | CARL R SCHWABE APNP
-----------------------------------------------------
Gender | Male
-----------------------------------------------------
=====================================================
Dates
=====================================================
Enumeration Date | 09/04/2013
-----------------------------------------------------
Last Update Date | 06/28/2020
-----------------------------------------------------
=====================================================
Provider Practice Location Address
=====================================================
Address Line | 9900 BREN RD E
-----------------------------------------------------
City | MINNETONKA
-----------------------------------------------------
State | MN
-----------------------------------------------------
Zip | 55343-9664
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 262-573-8527
-----------------------------------------------------
Fax |
-----------------------------------------------------
=====================================================
Provider Business Mailing Address
=====================================================
Address Line | 244 QUAIL CIR
-----------------------------------------------------
City | WEST BEND
-----------------------------------------------------
State | WI
-----------------------------------------------------
Zip | 53095-7900
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 262-573-8527
-----------------------------------------------------
Fax |
-----------------------------------------------------
=====================================================
Authorized Official
=====================================================
Title or Position |
-----------------------------------------------------
Name |
-----------------------------------------------------
Credential |
-----------------------------------------------------
Telephone |
-----------------------------------------------------
=====================================================
Scope of Practice (Provider's specialty)
=====================================================
Taxonomy #1
-----------------------------------------------------
Taxonomy Code | 363LF0000X
-----------------------------------------------------
Taxonomy Name | Family Nurse Practitioner
-----------------------------------------------------
License Number | 5306-33
-----------------------------------------------------
License Number State | WI
-----------------------------------------------------