MEDICARE: MRS. KERRY SCHNEIDER RN

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	163WG0600X	Gerontology Registered Nurse	0257569	MN
2	163WH0200X	Home Health Registered Nurse	R129045-3	MN
3	163WH0200X	Home Health Registered Nurse	172245-030	WI

General Provider Information

NPI Number	:	1811263031
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	MRS. KERRY SCHNEIDER RN

Provider Business Mailing Address
First Line	:	2980 RICE ST
Second Line	:
City	:	LITTLE CANADA
State	:	MN
Zip	:	55113-2230
Country	:	US
Telephone Number	:
Fax Number	:

Provider Business Practice Location Address
First Line	:	2980 RICE ST
Second Line	:
City	:	LITTLE CANADA
State	:	MN
Zip	:	55113-2230
Country	:	US
Telephone Number	:	651-488-4655
Fax Number	:	651-488-4656

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

Provider Enumeration Date	:	04/02/2012
Last Update Date	:	04/02/2012

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