Healthcare Provider Details

I. General information

NPI: 1740529858
Provider Name (Legal Business Name): JOHANNA ELLEN SCHNELL P.L.A.
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 02/08/2013
Last Update Date: 02/08/2013
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

30672 SUNNY BEACH RD
GRAND RAPIDS MN
55744-4891
US

IV. Provider business mailing address

30672 SUNNY BEACH RD
GRAND RAPIDS MN
55744-4891
US

V. Phone/Fax

Practice location:
  • Phone: 319-360-7351
  • Fax:
Mailing address:
  • Phone: 319-360-7351
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code174H00000X
TaxonomyHealth Educator
License Number
License Number State
# 2
Primary TaxonomyN
Taxonomy Code174N00000X
TaxonomyLactation Consultant (Non-RN)
License Number
License Number State
# 3
Primary TaxonomyY
Taxonomy Code374J00000X
TaxonomyDoula
License Number
License Number State

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: