Healthcare Provider Details

I. General information

NPI: 1144474271
Provider Name (Legal Business Name): JANE SCHANTZ FNP
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 11/17/2008
Last Update Date: 03/07/2023
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

402 N CAYUGA ST
ITHACA NY
14850-4219
US

IV. Provider business mailing address

402 N CAYUGA ST
ITHACA NY
14850-4219
US

V. Phone/Fax

Practice location:
  • Phone: 607-273-5551
  • Fax: 607-275-0313
Mailing address:
  • Phone: 607-273-5551
  • Fax: 607-275-0313

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code363LF0000X
TaxonomyFamily Nurse Practitioner
License NumberF335676-1
License Number StateNY

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: