Healthcare Provider Details

I. General information

NPI: 1225234693
Provider Name (Legal Business Name): JENNIFER F. SCHOPP CRNA
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 06/22/2007
Last Update Date: 05/20/2008
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

108 MASTERSPOINT DR
BROUSSARD LA
70518-6168
US

IV. Provider business mailing address

108 MASTERSPOINT DR
BROUSSARD LA
70518-6168
US

V. Phone/Fax

Practice location:
  • Phone: 504-343-7369
  • Fax: 866-634-4148
Mailing address:
  • Phone: 504-343-7369
  • Fax: 866-634-4148

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code367500000X
TaxonomyCertified Registered Nurse Anesthetist
License Number05214
License Number StateLA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: