Provider Demographics
NPI:1558368886
Name:SCHAEFF, JENNIFER L (PA-C)
Entity Type:Individual
Prefix:
First Name:JENNIFER
Middle Name:L
Last Name:SCHAEFF
Suffix:
Gender:F
Credentials:PA-C
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:39242 DEQUINDRE RD
Mailing Address - Street 2:SUITE 105
Mailing Address - City:STERLING HTS
Mailing Address - State:MI
Mailing Address - Zip Code:48310-1764
Mailing Address - Country:US
Mailing Address - Phone:586-979-1750
Mailing Address - Fax:586-979-4667
Practice Address - Street 1:39242 DEQUINDRE RD
Practice Address - Street 2:SUITE 105
Practice Address - City:STERLING HTS
Practice Address - State:MI
Practice Address - Zip Code:48310-1764
Practice Address - Country:US
Practice Address - Phone:586-979-1750
Practice Address - Fax:586-979-4667
Is Sole Proprietor?:No
Enumeration Date:2005-07-01
Last Update Date:2008-06-27
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MI5601003865363A00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363A00000XPhysician Assistants & Advanced Practice Nursing ProvidersPhysician Assistant
Provider Identifiers
StateIdentifier IDID TypeIssuer
MI0755014260OtherBCBSM
MI0P4771002Medicare PIN
MI0N69640Medicare ID - Type Unspecified