Provider Demographics
NPI:1437137650
Name:SCHAFER, JOANN (NP)
Entity Type:Individual
Prefix:MRS
First Name:JOANN
Middle Name:
Last Name:SCHAFER
Suffix:
Gender:F
Credentials:NP
Other - Prefix:MRS
Other - First Name:JOANN
Other - Middle Name:
Other - Last Name:SCHAFER
Other - Suffix:
Other - Last Name Type:Professional Name
Other - Credentials:NP
Mailing Address - Street 1:5189 W 600 N
Mailing Address - Street 2:
Mailing Address - City:MCCORDSVILLE
Mailing Address - State:IN
Mailing Address - Zip Code:46055-9715
Mailing Address - Country:US
Mailing Address - Phone:317-335-5189
Mailing Address - Fax:317-324-4073
Practice Address - Street 1:5189 WEST 600 N
Practice Address - Street 2:
Practice Address - City:MCCORDSVILLE
Practice Address - State:IN
Practice Address - Zip Code:46055
Practice Address - Country:US
Practice Address - Phone:317-355-5189
Practice Address - Fax:317-324-4047
Is Sole Proprietor?:Yes
Enumeration Date:2006-01-06
Last Update Date:2014-03-06
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IN71002588A363LA2200X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LA2200XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerAdult Health
Provider Identifiers
StateIdentifier IDID TypeIssuer
MIS71785Medicare UPIN