Healthcare Provider Details

I. General information

NPI: 1679756910
Provider Name (Legal Business Name): JO ANN SCHROEDER C.N.P.
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 12/10/2007
Last Update Date: 06/16/2018
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

49TH MEDICAL GROUP/SGPF 280 FIRST ST BLDG 23
HOLLOMAN AFB NM
88330-8273
US

IV. Provider business mailing address

49TH MEDICAL GROUP/SGPF 280 FIRST STREET, BLDG 23
HOLLOMAN AFB NM
88330-8273
US

V. Phone/Fax

Practice location:
  • Phone: 575-572-4889
  • Fax: 575-572-2259
Mailing address:
  • Phone: 575-572-4889
  • Fax: 575-572-2259

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code363L00000X
TaxonomyNurse Practitioner
License NumberR57915
License Number StateNM
# 2
Primary TaxonomyN
Taxonomy Code363LA2200X
TaxonomyAdult Health Nurse Practitioner
License NumberCNP01373
License Number StateNM
# 3
Primary TaxonomyY
Taxonomy Code363LP2300X
TaxonomyPrimary Care Nurse Practitioner
License NumberCNP01373
License Number StateNM

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: