1164421566 NPI number — MS. JENNIFER CROWE SCHUTTE FNP

Table of content: MS. JENNIFER CROWE SCHUTTE FNP (NPI 1164421566)

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1164421566 NPI number — MS. JENNIFER CROWE SCHUTTE FNP

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
Provider Last Name:
SCHUTTE
Provider First Name:
JENNIFER
Provider Middle Name:
CROWE
Provider Name Prefix Text:
MS.
Provider Name Suffix Text:
Provider Credential Text:
FNP
Provider Gender Code:
F

Provider's Other Name Information

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 Information

NPI Number:
1164421566
Entity Type Code:
Individual
Replacement NPI:
Last Update Date:
08/15/2014
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
5204 BERNARD DRIVE
Provider Second Line Business Mailing Address:
SUITE 300 A MARATHON HEALTH, LLC
Provider Business Mailing Address City Name:
ROANOKE
Provider Business Mailing Address State Name:
VA
Provider Business Mailing Address Postal Code:
24018
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
540-777-6355
Provider Business Mailing Address Fax Number:
540-772-2112

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
1970 ROANOKE BLVD
Provider Second Line Business Practice Location Address:
Provider Business Practice Location Address City Name:
SALEM
Provider Business Practice Location Address State Name:
VA
Provider Business Practice Location Address Postal Code:
24153-6404
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
540-982-2463
Provider Business Practice Location Address Fax Number:
Provider Enumeration Date:
07/18/2005

Additional Information

Authorized Official

Authorized Official Last Name:
Authorized Official First Name:
Authorized Official Middle Name:
Authorized Official Title or Position:
Authorized Official Telephone Number:

Provider Taxonomy Codes

  • Taxonomy code: 363L00000X , with the licence number:  0024165784 , registered in the state of VA ; information, associated with the NPI states the following Primary Taxonomy Switch: "Y" .
  • Taxonomy code: 363L00000X , with the licence number: 0110001871 , registered in the state of VA ; information, associated with the NPI states the following Primary Taxonomy Switch: "N" .

Other Provider's Identifiers (legacy, non-NPI)





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