Provider Demographics
NPI:1316743032
Name:SCHUCKMAN, PATTIE S
Entity type:Individual
Prefix:
First Name:PATTIE
Middle Name:S
Last Name:SCHUCKMAN
Suffix:
Gender:
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1206 N 9TH ST
Mailing Address - Street 2:
Mailing Address - City:NORFOLK
Mailing Address - State:NE
Mailing Address - Zip Code:68701-2822
Mailing Address - Country:US
Mailing Address - Phone:402-640-1040
Mailing Address - Fax:
Practice Address - Street 1:1206 N 9TH ST
Practice Address - Street 2:
Practice Address - City:NORFOLK
Practice Address - State:NE
Practice Address - Zip Code:68701-2822
Practice Address - Country:US
Practice Address - Phone:402-640-1040
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2025-02-22
Last Update Date:2025-02-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NE372600000X, 3747P1801X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes3747P1801XNursing Service Related ProvidersTechnicianPersonal Care Attendant
No372600000XNursing Service Related ProvidersAdult Companion