Provider Demographics
NPI:1356378830
Name:SCHOEPPEY, TRUDY F (PA)
Entity type:Individual
Prefix:
First Name:TRUDY
Middle Name:F
Last Name:SCHOEPPEY
Suffix:
Gender:F
Credentials:PA
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1711 S STEPHENSON AVE
Mailing Address - Street 2:SUITE 125
Mailing Address - City:IRON MOUNTAIN
Mailing Address - State:MI
Mailing Address - Zip Code:49801-3639
Mailing Address - Country:US
Mailing Address - Phone:906-774-1633
Mailing Address - Fax:906-774-4451
Practice Address - Street 1:1711 S STEPHENSON AVE
Practice Address - Street 2:SUITE 125
Practice Address - City:IRON MOUNTAIN
Practice Address - State:MI
Practice Address - Zip Code:49801-3639
Practice Address - Country:US
Practice Address - Phone:906-774-1633
Practice Address - Fax:906-774-4451
Is Sole Proprietor?:No
Enumeration Date:2006-06-28
Last Update Date:2007-10-29
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MI5601002442363AM0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363AM0700XPhysician Assistants & Advanced Practice Nursing ProvidersPhysician AssistantMedical
Provider Identifiers
StateIdentifier IDID TypeIssuer
WI30333700Medicaid
01007242OtherPREFERRED ONE ID
MIB43160Medicare UPIN
WI30333700Medicaid
MI233872Medicare ID - Type UnspecifiedRURAL HEALTH CLINIC