Provider Demographics
NPI:1578694394
Name:SCHMALZ, JACQUETTA MAY (CNA)
Entity Type:Individual
Prefix:MS
First Name:JACQUETTA
Middle Name:MAY
Last Name:SCHMALZ
Suffix:
Gender:F
Credentials:CNA
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1600 19 RD
Mailing Address - Street 2:
Mailing Address - City:FRUITA
Mailing Address - State:CO
Mailing Address - Zip Code:81521-9605
Mailing Address - Country:US
Mailing Address - Phone:970-858-1818
Mailing Address - Fax:
Practice Address - Street 1:1600 19 RD
Practice Address - Street 2:
Practice Address - City:FRUITA
Practice Address - State:CO
Practice Address - Zip Code:81521-9605
Practice Address - Country:US
Practice Address - Phone:970-858-1818
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2007-03-07
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CO158506171W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes171W00000XOther Service ProvidersContractor