1821292277 NPI number — JENNIFER A SCHAEFFER FNP-BC

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1821292277 NPI number — JENNIFER A SCHAEFFER FNP-BC

Employer Identification Number (EIN):

Provider Organization Name:

Provider Last Name:

SCHAEFFER

Provider First Name:

JENNIFER

Provider Middle Name:

A

Provider Name Prefix Text:

Provider Name Suffix Text:

Provider Credential Text:

FNP-BC

Provider Gender Code:

F

Provider Other Organization Name:

Provider Other Organization Name Type Code:

Provider Other Last Name:

Provider Other First Name:

Provider Other Middle Name:

Provider Other Name Prefix Text:

Provider Other Name Suffix Text:

Provider Other Credential Text:

Provider Other Last Name Type Code:

NPI Number:

1821292277

Entity Type Code:

Individual

Replacement NPI:

Last Update Date:

06/30/2020

NPI Deactivation Reason Code:

NPI Deactivation Date:

NPI Reactivation Date:

Provider First Line Business Mailing Address:

40819 N 3RD AVE

Provider Second Line Business Mailing Address:

Provider Business Mailing Address City Name:

PHOENIX

Provider Business Mailing Address State Name:

AZ

Provider Business Mailing Address Postal Code:

85086-8914

Provider Business Mailing Address Country Code:

US

Provider Business Mailing Address Telephone Number:

Provider Business Mailing Address Fax Number:

Provider First Line Business Practice Location Address:

9900 BREN RD E

Provider Second Line Business Practice Location Address:

Provider Business Practice Location Address City Name:

MINNETONKA

Provider Business Practice Location Address State Name:

MN

Provider Business Practice Location Address Postal Code:

55343-9664

Provider Business Practice Location Address Country Code:

US

Provider Business Practice Location Address Telephone Number:

602-291-7794

Provider Business Practice Location Address Fax Number:

Provider Enumeration Date:

06/11/2007

Authorized Official Last Name:

Authorized Official First Name:

Authorized Official Middle Name:

Authorized Official Title or Position:

Authorized Official Telephone Number:

• Taxonomy code: 363LF0000X , with the licence number:  187975 , registered in the state of CO ; information, associated with the NPI states the following Primary Taxonomy Switch: "N" .
• Taxonomy code: 363LF0000X , with the licence number: A116866 , registered in the state of IA ; information, associated with the NPI states the following Primary Taxonomy Switch: "N" .
• Taxonomy code: 363LF0000X , with the licence number: 3749 , registered in the state of AZ ; information, associated with the NPI states the following Primary Taxonomy Switch: "Y" .

• Identifier: 5550830009 . This is a "MEDICARE NSC AZ NORTH" identifier , issued by the state of ( AZ ) . This identifiers is of the category "OTHER".
• Identifier: 5550830004 . This is a "MEDICARE NSC PV" identifier , issued by the state of ( AZ ) . This identifiers is of the category "OTHER".
• Identifier: 5550830001 . This is a "MEDICARE NSC SCW" identifier , issued by the state of ( AZ ) . This identifiers is of the category "OTHER".
• Identifier: 5550830008 . This is a "MEDICARE NSC SWV" identifier , issued by the state of ( AZ ) . This identifiers is of the category "OTHER".
• Identifier: 5550830010 . This is a "MEDICARE NSC GILBERT" identifier , issued by the state of ( AZ ) . This identifiers is of the category "OTHER".
• Identifier: 506835 , issued by the state of ( AZ ) . This identifiers is of the category "MEDICAID".
• Identifier: 5550830003 . This is a "MEDICARE NSC PEORIA" identifier , issued by the state of ( AZ ) . This identifiers is of the category "OTHER".
• Identifier: 5550830006 . This is a "MEDICARE NSC ANTHEM" identifier , issued by the state of ( AZ ) . This identifiers is of the category "OTHER".
• Identifier: 5550830007 . This is a "MEDICARE NSC DV" identifier , issued by the state of ( AZ ) . This identifiers is of the category "OTHER".