Provider Demographics
NPI:1285354696
Name:SCHRAM, VICKIE H
Entity type:Individual
Prefix:
First Name:VICKIE
Middle Name:H
Last Name:SCHRAM
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:590 MOUNTAIN VIEW DR
Mailing Address - Street 2:
Mailing Address - City:WYTHEVILLE
Mailing Address - State:VA
Mailing Address - Zip Code:24382-1222
Mailing Address - Country:US
Mailing Address - Phone:276-613-5264
Mailing Address - Fax:
Practice Address - Street 1:329 DELLBROOK LN
Practice Address - Street 2:
Practice Address - City:INDEPENDENCE
Practice Address - State:VA
Practice Address - Zip Code:24348-3705
Practice Address - Country:US
Practice Address - Phone:276-773-1861
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2022-08-29
Last Update Date:2022-08-29
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
VA0402003969124Q00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes124Q00000XDental ProvidersDental Hygienist