Provider Demographics
NPI:1184714446
Name:SCHROTH-SEILER, BETH ELLEN (PA-C)
Entity type:Individual
Prefix:MISS
First Name:BETH
Middle Name:ELLEN
Last Name:SCHROTH-SEILER
Suffix:
Gender:F
Credentials:PA-C
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:801 YORK ST
Mailing Address - Street 2:
Mailing Address - City:MANITOWOC
Mailing Address - State:WI
Mailing Address - Zip Code:54220-4630
Mailing Address - Country:US
Mailing Address - Phone:920-683-5278
Mailing Address - Fax:920-686-9674
Practice Address - Street 1:2806 RIVERVIEW DR
Practice Address - Street 2:
Practice Address - City:GREEN BAY
Practice Address - State:WI
Practice Address - Zip Code:54313-6717
Practice Address - Country:US
Practice Address - Phone:920-498-7546
Practice Address - Fax:920-569-4129
Is Sole Proprietor?:No
Enumeration Date:2006-10-14
Last Update Date:2021-02-23
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TXPA04178363A00000X
WI2060-023363A00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363A00000XPhysician Assistants & Advanced Practice Nursing ProvidersPhysician Assistant
Provider Identifiers
StateIdentifier IDID TypeIssuer
WIP00360298OtherRAILROAD MEDICARE
WI2060-023OtherSTATE LICENSE
WIMS1492317OtherDEA
WI41946700Medicaid
WIP00360298OtherRAILROAD MEDICARE
WI000917140Medicare PIN