Basic Information
| Provider Information | |||||||||
| NPI: | 1548511371 | ||||||||
| EntityType: | 1 | ||||||||
| ReplacementNPI: | |||||||||
| OrganizationName: | |||||||||
| LastName: | SCHLICHT | ||||||||
| FirstName: | CALLIE | ||||||||
| MiddleName: | JAE | ||||||||
| NamePrefix: | |||||||||
| NameSuffix: | |||||||||
| Credential: | ANP-BC | ||||||||
| OtherOrganizationName: | |||||||||
| OtherOrganizationType: | |||||||||
| OtherLastName: | CHIROFF | ||||||||
| OtherFirstName: | CALLIE | ||||||||
| OtherMiddleName: | JAE | ||||||||
| OtherNamePrefix: | |||||||||
| OtherNameSuffix: | |||||||||
| OtherCredential: | ANP-BC | ||||||||
| OtherLastNameType: | 1 | ||||||||
| Mailing Information | |||||||||
| Address1: | 5434 W CAPITOL DR | ||||||||
| Address2: | UNIT 3 | ||||||||
| City: | MILWAUKEE | ||||||||
| State: | WI | ||||||||
| PostalCode: | 532162298 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 4148750505 | ||||||||
| FaxNumber: | |||||||||
| Practice Location | |||||||||
| Address1: | 5434 W CAPITOL DR | ||||||||
| Address2: | UNIT 3 | ||||||||
| City: | MILWAUKEE | ||||||||
| State: | WI | ||||||||
| PostalCode: | 532162298 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 4148750505 | ||||||||
| FaxNumber: | |||||||||
| Other Information | |||||||||
| ProviderEnumerationDate: | 09/19/2012 | ||||||||
| LastUpdateDate: | 02/01/2016 | ||||||||
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| NPIReactivationDate: | |||||||||
| ProviderGenderCode: | F | ||||||||
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| AuthorizedOfficialMiddleName: | |||||||||
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| IsSoleProprietor: | N | ||||||||
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| NPICertificationDate: | |||||||||
Taxonomy Information
| Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 363LA2200X | 5003-33 | WI | Y | Physician Assistants & Advanced Practice Nursing Providers | Nurse Practitioner | Adult Health |
ID Information
| ID | Type | State | Issuer | Description | 1548511371 | 05 | WI | MEDICAID |