MEDICARE: JENNIFER SHOEMAKER RN

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	163WI0500X	Infusion Therapy Registered Nurse	098596	MO

General Provider Information

NPI Number	:	1174484612
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	JENNIFER SHOEMAKER RN

Provider Business Mailing Address
First Line	:	110 ALGONQUIN DR
Second Line	:
City	:	LAKE WINNEBAGO
State	:	MO
Zip	:	64034-9301
Country	:	US
Telephone Number	:	816-668-9499
Fax Number	:

Provider Business Practice Location Address
First Line	:	110 ALGONQUIN DR
Second Line	:
City	:	LAKE WINNEBAGO
State	:	MO
Zip	:	64034-9301
Country	:	US
Telephone Number	:	816-668-9499
Fax Number	:

Authorized Official
Title or Position	:
Name	:
Credential	:
Telephone Number	:

Provider Enumeration Date	:	11/24/2025
Last Update Date	:	11/24/2025

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