Provider Demographics
NPI:1992937445
Name:SCHONEWALD, ILSE DAWN (LPN)
Entity type:Individual
Prefix:MISS
First Name:ILSE
Middle Name:DAWN
Last Name:SCHONEWALD
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 1:821 EAST MAIN STREET APTC-4
Mailing Address - Street 2:
Mailing Address - City:RIVERHEAD
Mailing Address - State:NY
Mailing Address - Zip Code:11901
Mailing Address - Country:US
Mailing Address - Phone:631-284-3176
Mailing Address - Fax:
Practice Address - Street 1:821 E MAIN ST
Practice Address - Street 2:C-4
Practice Address - City:RIVERHEAD
Practice Address - State:NY
Practice Address - Zip Code:11901-2500
Practice Address - Country:US
Practice Address - Phone:631-284-3176
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2009-08-18
Last Update Date:2009-08-18
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY282841-1164W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes164W00000XNursing Service ProvidersLicensed Practical Nurse