Healthcare Provider Details

I. General information

NPI: 1528350733
Provider Name (Legal Business Name): JENNY E SCHMITT APN
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 05/05/2011
Last Update Date: 12/15/2015
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

320 E ARMSTRONG AVE
PEORIA IL
61603-3172
US

IV. Provider business mailing address

320 E ARMSTRONG AVE
PEORIA IL
61603
US

V. Phone/Fax

Practice location:
  • Phone: 309-680-7600
  • Fax: 309-495-8614
Mailing address:
  • Phone: 309-680-7600
  • Fax: 309-495-8614

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code363L00000X
TaxonomyNurse Practitioner
License Number209-008794
License Number StateIL

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: