Healthcare Provider Details

I. General information

NPI: 1710015680
Provider Name (Legal Business Name): JAN MARIE SCHROEDER CNP
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 03/01/2007
Last Update Date: 08/15/2023
Certification Date: 08/15/2023
Deactivation Date:
Reactivation Date:

III. Provider practice location address

3224 JARVIS RD
LIMA OH
45807-2213
US

IV. Provider business mailing address

3224 JARVIS RD
LIMA OH
45807-2213
US

V. Phone/Fax

Practice location:
  • Phone: 419-996-5757
  • Fax: 419-996-5913
Mailing address:
  • Phone: 419-996-5757
  • Fax: 419-996-5913

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code363LF0000X
TaxonomyFamily Nurse Practitioner
License Number09021
License Number StateOH
# 2
Primary TaxonomyY
Taxonomy Code363LF0000X
TaxonomyFamily Nurse Practitioner
License NumberAPRN.CNP.09021
License Number StateOH

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: