1679756910 NPI number — JO ANN SCHROEDER C.N.P.

Table of content: JO ANN SCHROEDER C.N.P. (NPI 1679756910)

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1679756910 NPI number — JO ANN SCHROEDER C.N.P.

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
Provider Last Name:
SCHROEDER
Provider First Name:
JO
Provider Middle Name:
ANN
Provider Name Prefix Text:
Provider Name Suffix Text:
Provider Credential Text:
C.N.P.
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:
1679756910
Entity Type Code:
Individual
Replacement NPI:
Last Update Date:
06/16/2018
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
49TH MEDICAL GROUP/SGPF
Provider Second Line Business Mailing Address:
280 FIRST STREET, BLDG 23
Provider Business Mailing Address City Name:
HOLLOMAN AFB
Provider Business Mailing Address State Name:
NM
Provider Business Mailing Address Postal Code:
88330-8273
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
575-572-4889
Provider Business Mailing Address Fax Number:
575-572-2259

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
49TH MEDICAL GROUP/SGPF
Provider Second Line Business Practice Location Address:
280 FIRST ST BLDG 23
Provider Business Practice Location Address City Name:
HOLLOMAN AFB
Provider Business Practice Location Address State Name:
NM
Provider Business Practice Location Address Postal Code:
88330-8273
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
575-572-4889
Provider Business Practice Location Address Fax Number:
575-572-2259
Provider Enumeration Date:
12/10/2007

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:  R57915 , registered in the state of NM ; information, associated with the NPI states the following Primary Taxonomy Switch: "N" .
  • Taxonomy code: 363LA2200X , with the licence number: CNP01373 , registered in the state of NM ; information, associated with the NPI states the following Primary Taxonomy Switch: "N" .
  • Taxonomy code: 363LP2300X , with the licence number: CNP01373 , registered in the state of NM ; information, associated with the NPI states the following Primary Taxonomy Switch: "Y" .

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





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