Provider Demographics
NPI:1992092381
Name:SCHNEIDERWENT, CARISSA ANN (LPN)
Entity type:Individual
Prefix:MS
First Name:CARISSA
Middle Name:ANN
Last Name:SCHNEIDERWENT
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 1:2203 PLYMOUTH LN
Mailing Address - Street 2:
Mailing Address - City:SHEBOYGAN
Mailing Address - State:WI
Mailing Address - Zip Code:53081-5630
Mailing Address - Country:US
Mailing Address - Phone:920-912-1232
Mailing Address - Fax:
Practice Address - Street 1:2203 PLYMOUTH LN
Practice Address - Street 2:
Practice Address - City:SHEBOYGAN
Practice Address - State:WI
Practice Address - Zip Code:53081-5630
Practice Address - Country:US
Practice Address - Phone:920-912-1232
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2011-07-06
Last Update Date:2012-07-03
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WI313751031164W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes164W00000XNursing Service ProvidersLicensed Practical Nurse