Provider Demographics
NPI:1154741528
Name:GSCHIEDMEIER, NOVIA (LAC)
Entity type:Individual
Prefix:MS
First Name:NOVIA
Middle Name:
Last Name:GSCHIEDMEIER
Suffix:
Gender:F
Credentials:LAC
Other - Prefix:MS
Other - First Name:NOVIA
Other - Middle Name:
Other - Last Name:KOSSOW
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:LAC
Mailing Address - Street 1:17040 W GREENFIELD AVE STE 6
Mailing Address - Street 2:
Mailing Address - City:BROOKFIELD
Mailing Address - State:WI
Mailing Address - Zip Code:53005-6844
Mailing Address - Country:US
Mailing Address - Phone:414-241-5886
Mailing Address - Fax:
Practice Address - Street 1:17040 W GREENFIELD AVE STE 6
Practice Address - Street 2:
Practice Address - City:BROOKFIELD
Practice Address - State:WI
Practice Address - Zip Code:53005-6844
Practice Address - Country:US
Practice Address - Phone:414-241-5886
Practice Address - Fax:262-289-9310
Is Sole Proprietor?:No
Enumeration Date:2014-04-23
Last Update Date:2024-08-06
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WI822-55171100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes171100000XOther Service ProvidersAcupuncturist