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General NPI Number Information
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NPI Number | 1134129109
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Entity Type | Individual
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Provider Name | JEAN SCHUMAKER PAC
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Gender | Female
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Dates
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Enumeration Date | 07/29/2005
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Last Update Date | 02/27/2018
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Provider Practice Location Address
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Address Line | 340 W LINCOLN ST SUITE 540
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City | BELLEVILLE
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State | IL
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Zip | 62220-1900
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Country | US
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Telephone | 618-222-1341
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Fax | 618-222-1487
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Provider Business Mailing Address
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Address Line | 340 W LINCOLN ST SUITE 540
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City | BELLEVILLE
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State | IL
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Zip | 62220-1900
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Country | US
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Telephone | 618-222-1341
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Fax | 618-222-1487
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Authorized Official
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Title or Position |
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Name |
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Credential |
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Telephone |
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 363AM0700X
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Taxonomy Name | Medical Physician Assistant
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License Number | 50-00-2092
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License Number State | OH
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Taxonomy #2
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Taxonomy Code | 363AS0400X
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Taxonomy Name | Surgical Physician Assistant
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License Number | PA6450
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License Number State | MA
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Taxonomy #3
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Taxonomy Code | 363AM0700X
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Taxonomy Name | Medical Physician Assistant
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License Number | 085-003172
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License Number State | IL
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