MEDICARE: JENNIFER SCHROEDER CRNA

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	174400000X	Specialist	28149162A	IN
2	367500000X	Certified Registered Nurse Anesthetist	051625	IL

General Provider Information

NPI Number	:	1275582967
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	JENNIFER SCHROEDER CRNA

Provider Business Mailing Address
First Line	:	PO BOX 353
Second Line	:
City	:	CRESCENT CITY
State	:	IL
Zip	:	60928-0353
Country	:	US
Telephone Number	:	773-860-5202
Fax Number	:

Provider Business Practice Location Address
First Line	:	196267 S. LAGRANGE RD
Second Line	:
City	:	MOKENA
State	:	IL
Zip	:	60448
Country	:	US
Telephone Number	:	773-860-5202
Fax Number	:

Authorized Official
Title or Position	:
Name	:
Credential	:
Telephone Number	:

Provider Enumeration Date	:	05/09/2006
Last Update Date	:	05/11/2023

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