Individual
KELLY M SCHAEFER
Active
Sole proprietor
No
Provider details
NPI number
Gender
F
Credential
PAC
Contact information
Practice address
1630 COMMANCHE AVE STE 102, GREEN BAY, WI 54313-5753
(920) 433-6000
(920) 430-4719
Mailing address
PO BOX 22487, GREEN BAY, WI 54305-2487
(920) 445-7222
(920) 445-7289
Taxonomy
Speciality
Code
Description
License number
State
363A00000X
Physician Assistant
Primary
3031
WI
Other
Other identifiers
Code
Description
Identifier
Issuer
State
01
—
1106582
NATIONAL COMMISSION ON CERTIFICATION OF PHYSICIAN ASSISTANTS
—
01
—
3031-23
WI STATE LIC
WI
Enumeration date
10/03/2012
Last updated
02/09/2022
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