MEDICARE: STEPHEN SCHOBERT LPN

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	164W00000X	Licensed Practical Nurse	2023004056	MO

General Provider Information

NPI Number	:	1255154829
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	STEPHEN SCHOBERT LPN

Provider Business Mailing Address
First Line	:	3003 FALLING LEAF CT
Second Line	:
City	:	COLUMBIA
State	:	MO
Zip	:	65201-3549
Country	:	US
Telephone Number	:
Fax Number	:

Provider Business Practice Location Address
First Line	:	3003 FALLING LEAF CT
Second Line	:
City	:	COLUMBIA
State	:	MO
Zip	:	65201-3549
Country	:	US
Telephone Number	:	573-814-5136
Fax Number	:

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

Provider Enumeration Date	:	11/04/2024
Last Update Date	:	11/04/2024

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