Healthcare Provider Details

I. General information

NPI: 1598763419
Provider Name (Legal Business Name): PENELOPE JANE SCHMICKER CNM
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 07/13/2005
Last Update Date: 09/26/2008
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

6030 ROOSEVELT RD
OAK PARK IL
60304-2375
US

IV. Provider business mailing address

2055 W ARMY TRAIL RD SUITE 104
ADDISON IL
60101-1478
US

V. Phone/Fax

Practice location:
  • Phone: 708-386-0845
  • Fax: 708-386-8472
Mailing address:
  • Phone: 630-705-1010
  • Fax: 630-705-1049

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code176B00000X
TaxonomyMidwife
License Number04460
License Number StateOH

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: