Provider Demographics
NPI:1568448751
Name:SCHANTZ, JENNIFER KEESE (CNM)
Entity Type:Individual
Prefix:MS
First Name:JENNIFER
Middle Name:KEESE
Last Name:SCHANTZ
Suffix:
Gender:F
Credentials:CNM
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
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Other - Credentials:
Mailing Address - Street 1:18107 NE 201ST ST
Mailing Address - Street 2:
Mailing Address - City:BATTLE GROUND
Mailing Address - State:WA
Mailing Address - Zip Code:98604-3633
Mailing Address - Country:US
Mailing Address - Phone:360-666-8275
Mailing Address - Fax:360-882-0208
Practice Address - Street 1:406 SE 131ST AVE
Practice Address - Street 2:SUITE 109
Practice Address - City:VANCOUVER
Practice Address - State:WA
Practice Address - Zip Code:98683-4004
Practice Address - Country:US
Practice Address - Phone:360-885-7926
Practice Address - Fax:360-882-0208
Is Sole Proprietor?:Not Answered
Enumeration Date:2005-12-20
Last Update Date:2007-07-09
Deactivation Date:
Deactivation Code:
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Provider Licenses
StateLicense IDTaxonomies
WAAP30004478367A00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes367A00000XPhysician Assistants & Advanced Practice Nursing ProvidersAdvanced Practice Midwife
Provider Identifiers
StateIdentifier IDID TypeIssuer
WAP14441Medicare UPIN