Provider Demographics
NPI:1144345414
Name:SCHAUKOWITCH, DONALD TIMOTHY (NP)
Entity type:Individual
Prefix:
First Name:DONALD
Middle Name:TIMOTHY
Last Name:SCHAUKOWITCH
Suffix:
Gender:M
Credentials:NP
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:944 HENSLEY AVE
Mailing Address - Street 2:
Mailing Address - City:SAN BRUNO
Mailing Address - State:CA
Mailing Address - Zip Code:94066-3148
Mailing Address - Country:US
Mailing Address - Phone:650-873-3323
Mailing Address - Fax:
Practice Address - Street 1:218 DE ANZA BLVD
Practice Address - Street 2:
Practice Address - City:SAN MATEO
Practice Address - State:CA
Practice Address - Zip Code:94402-3913
Practice Address - Country:US
Practice Address - Phone:650-341-9131
Practice Address - Fax:650-341-9135
Is Sole Proprietor?:No
Enumeration Date:2007-03-19
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA296293363LF0000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LF0000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerFamily
Provider Identifiers
StateIdentifier IDID TypeIssuer
CA296293OtherCA BRN STATE LICENSE