Provider Demographics
NPI:1134129109
Name:SCHUMAKER, JEAN (PAC)
Entity Type:Individual
Prefix:
First Name:JEAN
Middle Name:
Last Name:SCHUMAKER
Suffix:
Gender:F
Credentials:PAC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:340 W LINCOLN ST
Mailing Address - Street 2:SUITE 540
Mailing Address - City:BELLEVILLE
Mailing Address - State:IL
Mailing Address - Zip Code:62220-1900
Mailing Address - Country:US
Mailing Address - Phone:618-222-1341
Mailing Address - Fax:618-222-1487
Practice Address - Street 1:340 W LINCOLN ST
Practice Address - Street 2:SUITE 540
Practice Address - City:BELLEVILLE
Practice Address - State:IL
Practice Address - Zip Code:62220-1900
Practice Address - Country:US
Practice Address - Phone:618-222-1341
Practice Address - Fax:618-222-1487
Is Sole Proprietor?:No
Enumeration Date:2005-07-29
Last Update Date:2018-02-27
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OH50-00-2092363AM0700X
MAPA6450363AS0400X
IL085-003172363AM0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363AM0700XPhysician Assistants & Advanced Practice Nursing ProvidersPhysician AssistantMedical
No363AS0400XPhysician Assistants & Advanced Practice Nursing ProvidersPhysician AssistantSurgical
Provider Identifiers
StateIdentifier IDID TypeIssuer
Q17134Medicare UPIN