Provider Demographics
NPI:1699920819
Name:SCHUMACHER, MICHELLE MARIE (PA-C)
Entity type:Individual
Prefix:
First Name:MICHELLE
Middle Name:MARIE
Last Name:SCHUMACHER
Suffix:
Gender:F
Credentials:PA-C
Other - Prefix:
Other - First Name:MICHELLE
Other - Middle Name:MARIE
Other - Last Name:TRAISER
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:PA-C
Mailing Address - Street 1:640 JACKSON ST
Mailing Address - Street 2:MAIL CODE 11102H
Mailing Address - City:SAINT PAUL
Mailing Address - State:MN
Mailing Address - Zip Code:55101-2502
Mailing Address - Country:US
Mailing Address - Phone:651-254-5175
Mailing Address - Fax:651-254-1603
Practice Address - Street 1:640 JACKSON ST
Practice Address - Street 2:MAIL CODE 11102H
Practice Address - City:SAINT PAUL
Practice Address - State:MN
Practice Address - Zip Code:55101-2502
Practice Address - Country:US
Practice Address - Phone:651-254-5175
Practice Address - Fax:651-254-1603
Is Sole Proprietor?:Yes
Enumeration Date:2008-12-02
Last Update Date:2008-12-02
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MN1229363A00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363A00000XPhysician Assistants & Advanced Practice Nursing ProvidersPhysician Assistant