Provider Demographics
NPI:1508267410
Name:SCHNEIDER, JORDAN MARK (RN)
Entity Type:Individual
Prefix:MR
First Name:JORDAN
Middle Name:MARK
Last Name:SCHNEIDER
Suffix:
Gender:M
Credentials:RN
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:524 PENNSYLVANIA AVE
Mailing Address - Street 2:
Mailing Address - City:WEST BEND
Mailing Address - State:WI
Mailing Address - Zip Code:53095-4138
Mailing Address - Country:US
Mailing Address - Phone:262-573-2044
Mailing Address - Fax:
Practice Address - Street 1:524 PENNSYLVANIA AVE
Practice Address - Street 2:
Practice Address - City:WEST BEND
Practice Address - State:WI
Practice Address - Zip Code:53095-4138
Practice Address - Country:US
Practice Address - Phone:262-573-2044
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2014-09-10
Last Update Date:2014-09-10
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WI193953-30163WH0200X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes163WH0200XNursing Service ProvidersRegistered NurseHome Health