Basic Information
| Provider Information | |||||||||
| NPI: | 1609357151 | ||||||||
| EntityType: | 1 | ||||||||
| ReplacementNPI: | |||||||||
| OrganizationName: | |||||||||
| LastName: | SCHMITT | ||||||||
| FirstName: | JESSICA | ||||||||
| MiddleName: | MARSH | ||||||||
| NamePrefix: | |||||||||
| NameSuffix: | |||||||||
| Credential: | CPNP | ||||||||
| OtherOrganizationName: | |||||||||
| OtherOrganizationType: | |||||||||
| OtherLastName: | SCHOENLEBER | ||||||||
| OtherFirstName: | JESSICA | ||||||||
| OtherMiddleName: | MARSH | ||||||||
| OtherNamePrefix: | |||||||||
| OtherNameSuffix: | |||||||||
| OtherCredential: | RN | ||||||||
| OtherLastNameType: | 1 | ||||||||
| Mailing Information | |||||||||
| Address1: | 180 COUNTY ROAD B2 E APT 22 | ||||||||
| Address2: | |||||||||
| City: | LITTLE CANADA | ||||||||
| State: | MN | ||||||||
| PostalCode: | 551171516 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 6513578431 | ||||||||
| FaxNumber: | |||||||||
| Practice Location | |||||||||
| Address1: | 1825 WOODWINDS DR | ||||||||
| Address2: | |||||||||
| City: | WOODBURY | ||||||||
| State: | MN | ||||||||
| PostalCode: | 551252202 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 6512326700 | ||||||||
| FaxNumber: | |||||||||
| Other Information | |||||||||
| ProviderEnumerationDate: | 08/23/2018 | ||||||||
| LastUpdateDate: | 08/23/2018 | ||||||||
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| NPIReactivationDate: | |||||||||
| ProviderGenderCode: | F | ||||||||
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| IsSoleProprietor: | N | ||||||||
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Taxonomy Information
| Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 163W00000X | 211926-1 | MN | N | Nursing Service Providers | Registered Nurse | 363LP0200X | 6096 | MN | Y | Physician Assistants & Advanced Practice Nursing Providers | Nurse Practitioner | Pediatrics |
No ID Information.