Healthcare Provider Details

I. General information

NPI: 1720342033
Provider Name (Legal Business Name): JENNIFER RUTH SCHOMAKER FNP, CNS
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 07/02/2012
Last Update Date: 08/19/2013
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

701 PARK AVE # P5
MINNEAPOLIS MN
55415-1623
US

IV. Provider business mailing address

9172 WHITE OAKS TRL
CHAMPLIN MN
55316-2674
US

V. Phone/Fax

Practice location:
  • Phone: 612-873-2428
  • Fax:
Mailing address:
  • Phone: 612-770-6288
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code364SA2200X
TaxonomyAdult Health Clinical Nurse Specialist
License NumberR 153252-2
License Number StateMN
# 2
Primary TaxonomyY
Taxonomy Code363LF0000X
TaxonomyFamily Nurse Practitioner
License Number2013007754
License Number StateMN

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: