Healthcare Provider Details

I. General information

NPI: 1528790953
Provider Name (Legal Business Name): SCOTT SCHNEIDER APRN
Entity Type: Individual
Gender: Male
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 06/24/2022
Last Update Date: 06/24/2022
Certification Date: 06/24/2022
Deactivation Date:
Reactivation Date:

III. Provider practice location address

514 CLEVELAND ST
GREAT BEND KS
67530-3562
US

IV. Provider business mailing address

553 E 7TH ST
RUSSELL KS
67665-2211
US

V. Phone/Fax

Practice location:
  • Phone: 620-792-8833
  • Fax:
Mailing address:
  • Phone:
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code363LF0000X
TaxonomyFamily Nurse Practitioner
License Number5381313041
License Number StateKS

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: