Basic Information
| Provider Information | |||||||||
| NPI: | 1386603561 | ||||||||
| EntityType: | 1 | ||||||||
| ReplacementNPI: | |||||||||
| OrganizationName: | |||||||||
| LastName: | SCHEXNAYDRE | ||||||||
| FirstName: | EVON | ||||||||
| MiddleName: | LOUISE | ||||||||
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| Credential: | MD | ||||||||
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| Mailing Information | |||||||||
| Address1: | 953 SEMINOLE RD | ||||||||
| Address2: | |||||||||
| City: | NORTON SHORES | ||||||||
| State: | MI | ||||||||
| PostalCode: | 494414341 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 2317668945 | ||||||||
| FaxNumber: | 2317668952 | ||||||||
| Practice Location | |||||||||
| Address1: | 2251 N SHORE DR | ||||||||
| Address2: | |||||||||
| City: | RHINELANDER | ||||||||
| State: | WI | ||||||||
| PostalCode: | 545016710 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 7153614700 | ||||||||
| FaxNumber: | |||||||||
| Other Information | |||||||||
| ProviderEnumerationDate: | 03/17/2006 | ||||||||
| LastUpdateDate: | 02/05/2021 | ||||||||
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| ProviderGenderCode: | F | ||||||||
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| IsSoleProprietor: | N | ||||||||
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| NPICertificationDate: | 02/05/2021 | ||||||||
Taxonomy Information
| Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 207V00000X | 4301075975 | MI | Y | Allopathic & Osteopathic Physicians | Obstetrics & Gynecology |
ID Information
| ID | Type | State | Issuer | Description | DF4619 | 01 | MI | MEDICARE RR GRP PIN | OTHER | 0701138 | 01 | MI | BCBSM IND PIN | OTHER | 0P31360 | 01 | MI | MEDICARE GRP PIN | OTHER | 0G01131 | 01 | MI | BCBSM GRP PIN | OTHER |