Provider Demographics
NPI:1306838198
Name:SCHNEIDER, MARY THERESE (MD)
Entity Type:Individual
Prefix:DR
First Name:MARY
Middle Name:THERESE
Last Name:SCHNEIDER
Suffix:
Gender:F
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1000 JACKSON ST
Mailing Address - Street 2:
Mailing Address - City:SIOUX CITY
Mailing Address - State:IA
Mailing Address - Zip Code:51105-1431
Mailing Address - Country:US
Mailing Address - Phone:712-252-0501
Mailing Address - Fax:712-252-2024
Practice Address - Street 1:1000 JACKSON ST
Practice Address - Street 2:
Practice Address - City:SIOUX CITY
Practice Address - State:IA
Practice Address - Zip Code:51105-1431
Practice Address - Country:US
Practice Address - Phone:712-252-0501
Practice Address - Fax:712-252-2024
Is Sole Proprietor?:No
Enumeration Date:2005-08-17
Last Update Date:2022-08-04
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IA34022207V00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207V00000XAllopathic & Osteopathic PhysiciansObstetrics & Gynecology
Provider Identifiers
StateIdentifier IDID TypeIssuer
IA0235382Medicaid
SD6200940Medicaid
SD6200940Medicaid
IAH46459Medicare UPIN
SD8474Medicare PIN