Individual
MRS. SHANNON LEAH SCHMIDT
Active
Sole proprietor
No
Provider details
NPI number
Gender
F
Contact information
Practice address
2500 E CAPITOL DR, APPLETON, WI 54911-8735
(920) 364-3600
(920) 364-3900
Mailing address
PO BOX 8003, APPLETON, WI 54912-8003
(920) 830-5900
(920) 738-5787
Taxonomy
Speciality
Code
Description
License number
State
207R00000X
Internal Medicine Physician
55748
WI
207RH0003X
Hematology & Oncology Physician
Primary
55748
WI
Other
Other identifiers
Code
Description
Identifier
Issuer
State
01
—
K400321103
MEDICARE PTAN
WI
01
—
K400321104
MEDICARE PTAN
WI
01
—
K400321105
MEDICARE PTAN
WI
Enumeration date
03/31/2009
Last updated
09/01/2016
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