Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 363L00000X | Nurse Practitioner | 28222356A | IN |
NPI | 1003407321 |
---|---|
Provider Name | Kyla M Schauss |
First Address | Mishawaka, IN 46545-5592 |
Second Address | Mishawaka, IN 46545-5592 |
Gender | F |
NPI Entity type | Individual |
Is Sole Proprietor | No |
Is Organization Subpart | N/A |
Enumeration Date | 29/01/2021 |
Last Update Date | 29/01/2021 |
IDENTIFIER | TYPE / CODE | IDENTIFIER STATE |
---|---|---|
200817480A | (05) | IN |
200817480B | (05) | IN |