Healthcare Provider Details

I. General information

NPI: 1780751560
Provider Name (Legal Business Name): JENNIFER LYNN SCHUMAN CERTIFIED NURSE MIDW
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 11/29/2006
Last Update Date: 10/21/2016
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

2400 UNSER BLVD SE STE 28400
RIO RANCHO NM
87124-4740
US

IV. Provider business mailing address

PO BOX 26666 PHS PROVIDER ENROLLMENT
ALBUQUERQUE NM
87125-6666
US

V. Phone/Fax

Practice location:
  • Phone: 505-253-3000
  • Fax: 505-253-3001
Mailing address:
  • Phone: 505-923-6770
  • Fax: 505-923-5354

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code367A00000X
TaxonomyAdvanced Practice Midwife
License Number4704254040
License Number StateMI
# 2
Primary TaxonomyY
Taxonomy Code367A00000X
TaxonomyAdvanced Practice Midwife
License Number671
License Number StateNM

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: