Provider Demographics
NPI:1306800388
Name:SCHENCK, SANDRA ELAINE (LPN)
Entity type:Individual
Prefix:
First Name:SANDRA
Middle Name:ELAINE
Last Name:SCHENCK
Suffix:
Gender:F
Credentials:LPN
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:N8980 PAGEL RD
Mailing Address - Street 2:
Mailing Address - City:IOLA
Mailing Address - State:WI
Mailing Address - Zip Code:54945-9766
Mailing Address - Country:US
Mailing Address - Phone:715-445-2678
Mailing Address - Fax:
Practice Address - Street 1:N8980 PAGEL RD
Practice Address - Street 2:
Practice Address - City:IOLA
Practice Address - State:WI
Practice Address - Zip Code:54945-9766
Practice Address - Country:US
Practice Address - Phone:715-445-2678
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2006-04-14
Last Update Date:2007-07-09
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WI32203 031164W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes164W00000XNursing Service ProvidersLicensed Practical Nurse
Provider Identifiers
StateIdentifier IDID TypeIssuer
WI38237300Medicaid