Provider Demographics
NPI:1962585505
Name:SCHWALLIE, DEBORAH L (APNP)
Entity type:Individual
Prefix:
First Name:DEBORAH
Middle Name:L
Last Name:SCHWALLIE
Suffix:
Gender:F
Credentials:APNP
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1834 W WISCONSIN AVE
Mailing Address - Street 2:SUITE 100
Mailing Address - City:MILWAUKEE
Mailing Address - State:WI
Mailing Address - Zip Code:53233-2125
Mailing Address - Country:US
Mailing Address - Phone:414-933-9100
Mailing Address - Fax:414-933-9200
Practice Address - Street 1:W129N7055 NORTHFIELD DR
Practice Address - Street 2:
Practice Address - City:MENOMONEE FALLS
Practice Address - State:WI
Practice Address - Zip Code:53051-0538
Practice Address - Country:US
Practice Address - Phone:262-253-5401
Practice Address - Fax:920-328-9713
Is Sole Proprietor?:No
Enumeration Date:2006-10-24
Last Update Date:2024-08-29
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WI97-033364SC1501X, 363L00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363L00000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse Practitioner
No364SC1501XPhysician Assistants & Advanced Practice Nursing ProvidersClinical Nurse SpecialistCommunity Health/Public Health
Provider Identifiers
StateIdentifier IDID TypeIssuer
WI36029700Medicaid
WI00010202 8Medicare PIN
WI36029700Medicaid