Provider Demographics
NPI:1760657241
Name:SCHOEN, WANDA CAROL
Entity type:Individual
Prefix:MRS
First Name:WANDA
Middle Name:CAROL
Last Name:SCHOEN
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:PO BOX 1977
Mailing Address - Street 2:
Mailing Address - City:FAIRHOPE
Mailing Address - State:AL
Mailing Address - Zip Code:36533-1977
Mailing Address - Country:US
Mailing Address - Phone:251-990-8095
Mailing Address - Fax:251-990-8901
Practice Address - Street 1:300 MORPHY AVE
Practice Address - Street 2:
Practice Address - City:FAIRHOPE
Practice Address - State:AL
Practice Address - Zip Code:36532-2326
Practice Address - Country:US
Practice Address - Phone:251-990-8095
Practice Address - Fax:251-990-8901
Is Sole Proprietor?:Yes
Enumeration Date:2008-04-25
Last Update Date:2008-04-25
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
AL69212332B00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes332B00000XSuppliersDurable Medical Equipment & Medical Supplies
Provider Identifiers
StateIdentifier IDID TypeIssuer
AL51060616OtherBLUE CROSS BLUE SHIELD