Healthcare Provider Details

I. General information

NPI: 1356825822
Provider Name (Legal Business Name): JOSEPH SCHNEPP
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 09/20/2018
Last Update Date: 09/13/2023
Certification Date: 09/13/2023
Deactivation Date:
Reactivation Date:

III. Provider practice location address

2030 CHURCHMAN AVE
BEECH GROVE IN
46107-1044
US

IV. Provider business mailing address

PO BOX 781076
DETROIT MI
48278-1076
US

V. Phone/Fax

Practice location:
  • Phone: 317-786-9285
  • Fax: 317-781-2793
Mailing address:
  • Phone: 317-528-4800
  • Fax: 317-865-1479

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code363LF0000X
TaxonomyFamily Nurse Practitioner
License Number71008360A
License Number StateIN

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: