Healthcare Provider Details

I. General information

NPI: 1275582967
Provider Name (Legal Business Name): JENNIFER SCHROEDER CRNA
Entity Type: Individual
Gender: Female
Sole Proprietor: N

Provider Other Name: JENNIFER FEGAN CRNA

II. Dates (important events)

Enumeration Date: 05/09/2006
Last Update Date: 05/11/2023
Certification Date: 05/11/2023
Deactivation Date:
Reactivation Date:

III. Provider practice location address

196267 S. LAGRANGE RD
MOKENA IL
60448
US

IV. Provider business mailing address

PO BOX 353
CRESCENT CITY IL
60928-0353
US

V. Phone/Fax

Practice location:
  • Phone: 773-860-5202
  • Fax:
Mailing address:
  • Phone: 773-860-5202
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code174400000X
TaxonomySpecialist
License Number28149162A
License Number StateIN
# 2
Primary TaxonomyY
Taxonomy Code367500000X
TaxonomyCertified Registered Nurse Anesthetist
License Number051625
License Number StateIL

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: