MEDICARE: NATHANIEL LEVI SCHMOE

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	175T00000X	Peer Specialist		AK

General Provider Information

NPI Number	:	1033056221
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	NATHANIEL LEVI SCHMOE

Provider Business Mailing Address
First Line	:	300 N WILLOW ST
Second Line	:
City	:	WASILLA
State	:	AK
Zip	:	99654-7042
Country	:	US
Telephone Number	:
Fax Number	:

Provider Business Practice Location Address
First Line	:	300 N WILLOW ST
Second Line	:
City	:	WASILLA
State	:	AK
Zip	:	99654-7042
Country	:	US
Telephone Number	:	907-373-4357
Fax Number	:

Authorized Official
Title or Position	:
Name	:
Credential	:
Telephone Number	:

Provider Enumeration Date	:	05/04/2026
Last Update Date	:	05/04/2026

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