Healthcare Provider Details

I. General information

NPI: 1407163983
Provider Name (Legal Business Name): JENNIFER ANN BADER PA-C
Entity Type: Individual
Gender: Female
Sole Proprietor: N

Provider Other Name: JENNIFER ANN SCHUCKER PA-C

II. Dates (important events)

Enumeration Date: 09/07/2010
Last Update Date: 10/12/2017
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1020 FORREST AVE SUITE 1
DOVER DE
19904-2799
US

IV. Provider business mailing address

PO BOX 59
CLAYTON DE
19938-0059
US

V. Phone/Fax

Practice location:
  • Phone: 302-632-2048
  • Fax:
Mailing address:
  • Phone: 302-632-2048
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code146N00000X
TaxonomyBasic Emergency Medical Technician
License Number
License Number State
# 2
Primary TaxonomyY
Taxonomy Code363A00000X
TaxonomyPhysician Assistant
License NumberC5-0000728
License Number StateDE

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: