Healthcare Provider Details

I. General information

NPI: 1174904767
Provider Name (Legal Business Name): JESSICA L SCHNELL MD
Entity Type: Individual
Gender: Female
Sole Proprietor: N

Provider Other Name: JESSICA LANDER MD

II. Dates (important events)

Enumeration Date: 06/09/2015
Last Update Date: 03/06/2020
Certification Date: 03/06/2020
Deactivation Date:
Reactivation Date:

III. Provider practice location address

9000 W WISCONSIN AVE
MILWAUKEE WI
53226
US

IV. Provider business mailing address

9000 W WISCONSIN AVE
MILWAUKEE WI
53226-4874
US

V. Phone/Fax

Practice location:
  • Phone: 414-266-6700
  • Fax: 414-266-6695
Mailing address:
  • Phone: 414-266-6700
  • Fax: 414-266-6695

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code208000000X
TaxonomyPediatrics Physician
License Number125-067112
License Number StateIL
# 2
Primary TaxonomyN
Taxonomy Code2080P0216X
TaxonomyPediatric Rheumatology Physician
License Number69913
License Number StateWI
# 3
Primary TaxonomyY
Taxonomy Code208000000X
TaxonomyPediatrics Physician
License Number69913
License Number StateWI

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: