Provider Demographics
NPI:1215415799
Name:SCHMULBACH, BREE A (APN)
Entity type:Individual
Prefix:
First Name:BREE
Middle Name:A
Last Name:SCHMULBACH
Suffix:
Gender:F
Credentials:APN
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1 CENTRE DRIVE
Mailing Address - Street 2:
Mailing Address - City:PETERSBURG
Mailing Address - State:IL
Mailing Address - Zip Code:62675-9467
Mailing Address - Country:US
Mailing Address - Phone:217-632-7761
Mailing Address - Fax:217-632-0312
Practice Address - Street 1:1 CENTRE DRIVE
Practice Address - Street 2:
Practice Address - City:PETERSBURG
Practice Address - State:IL
Practice Address - Zip Code:62675-9467
Practice Address - Country:US
Practice Address - Phone:217-632-7761
Practice Address - Fax:217-632-0312
Is Sole Proprietor?:No
Enumeration Date:2018-08-06
Last Update Date:2024-10-25
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IL209017873363LF0000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LF0000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerFamily
Provider Identifiers
StateIdentifier IDID TypeIssuer
IL041346789OtherRN LICENSE