Healthcare Provider Details

I. General information

NPI: 1033356837
Provider Name (Legal Business Name): JEANNE B SCHRAMM NP
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 01/15/2009
Last Update Date: 08/14/2024
Certification Date: 08/14/2024
Deactivation Date:
Reactivation Date:

III. Provider practice location address

3175 LANCER ST
PORTAGE IN
46368-4407
US

IV. Provider business mailing address

PO BOX 678691
DALLAS TX
75267-8691
US

V. Phone/Fax

Practice location:
  • Phone: 219-762-9571
  • Fax:
Mailing address:
  • Phone: 972-758-3598
  • Fax: 972-599-9604

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code363LF0000X
TaxonomyFamily Nurse Practitioner
License Number209008076
License Number StateIL
# 2
Primary TaxonomyN
Taxonomy Code363L00000X
TaxonomyNurse Practitioner
License Number28135289A
License Number StateIN
# 3
Primary TaxonomyY
Taxonomy Code363LF0000X
TaxonomyFamily Nurse Practitioner
License Number71002802
License Number StateIN

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: