Provider Demographics
NPI:1396295598
Name:SCHEPP, CARRIE (LPN)
Entity type:Individual
Prefix:
First Name:CARRIE
Middle Name:
Last Name:SCHEPP
Suffix:
Gender:F
Credentials:LPN
Other - Prefix:
Other - First Name:CARRIE
Other - Middle Name:
Other - Last Name:JACOB
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:
Mailing Address - Street 1:1209 ERICK ST
Mailing Address - Street 2:
Mailing Address - City:FORT ATKINSON
Mailing Address - State:WI
Mailing Address - Zip Code:53538-2717
Mailing Address - Country:US
Mailing Address - Phone:608-212-4604
Mailing Address - Fax:
Practice Address - Street 1:1209 ERICK ST
Practice Address - Street 2:
Practice Address - City:FORT ATKINSON
Practice Address - State:WI
Practice Address - Zip Code:53538-2717
Practice Address - Country:US
Practice Address - Phone:608-212-4604
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2016-10-11
Last Update Date:2016-10-11
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WI317058164W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes164W00000XNursing Service ProvidersLicensed Practical Nurse