=====================================================
General NPI Number Information
=====================================================
NPI Number | 1114367190
-----------------------------------------------------
Entity Type | Individual
-----------------------------------------------------
Provider Name | DANIEL JUDE SCHNEBELEN MSN, APRN, NP-C
-----------------------------------------------------
Gender | Male
-----------------------------------------------------
=====================================================
Dates
=====================================================
Enumeration Date | 07/05/2013
-----------------------------------------------------
Last Update Date | 07/05/2013
-----------------------------------------------------
=====================================================
Provider Practice Location Address
=====================================================
Address Line | 14350 LA HIGHWAY 73
-----------------------------------------------------
City | PRAIRIEVILLE
-----------------------------------------------------
State | LA
-----------------------------------------------------
Zip | 70769-3617
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 225-313-3930
-----------------------------------------------------
Fax | 225-313-3940
-----------------------------------------------------
=====================================================
Provider Business Mailing Address
=====================================================
Address Line | 25335 HACKBERRY LN
-----------------------------------------------------
City | PLAQUEMINE
-----------------------------------------------------
State | LA
-----------------------------------------------------
Zip | 70764-4507
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 225-802-8080
-----------------------------------------------------
Fax |
-----------------------------------------------------
=====================================================
Authorized Official
=====================================================
Title or Position |
-----------------------------------------------------
Name |
-----------------------------------------------------
Credential |
-----------------------------------------------------
Telephone |
-----------------------------------------------------
=====================================================
Scope of Practice (Provider's specialty)
=====================================================
Taxonomy #1
-----------------------------------------------------
Taxonomy Code | 363LF0000X
-----------------------------------------------------
Taxonomy Name | Family Nurse Practitioner
-----------------------------------------------------
License Number | AP07371
-----------------------------------------------------
License Number State | LA
-----------------------------------------------------