Healthcare Provider Details

I. General information

NPI: 1578054490
Provider Name (Legal Business Name): JENNIFER M SCHNELKER
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 05/25/2018
Last Update Date: 06/16/2018
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

450 NEW WINCHESTER CENTER RD
BUCYRUS OH
44820-9538
US

IV. Provider business mailing address

450 NEW WINCHESTER CENTER RD
BUCYRUS OH
44820-9538
US

V. Phone/Fax

Practice location:
  • Phone: 419-961-4796
  • Fax:
Mailing address:
  • Phone: 419-961-4796
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code163WC0400X
TaxonomyCase Management Registered Nurse
License Number404995
License Number StateOH

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: