Provider Demographics
NPI:1598763419
Name:SCHMICKER, PENELOPE JANE (CNM)
Entity Type:Individual
Prefix:
First Name:PENELOPE
Middle Name:JANE
Last Name:SCHMICKER
Suffix:
Gender:F
Credentials:CNM
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:2055 W ARMY TRAIL RD
Mailing Address - Street 2:SUITE 104
Mailing Address - City:ADDISON
Mailing Address - State:IL
Mailing Address - Zip Code:60101-1478
Mailing Address - Country:US
Mailing Address - Phone:630-705-1010
Mailing Address - Fax:630-705-1049
Practice Address - Street 1:6030 ROOSEVELT RD
Practice Address - Street 2:
Practice Address - City:OAK PARK
Practice Address - State:IL
Practice Address - Zip Code:60304-2375
Practice Address - Country:US
Practice Address - Phone:708-386-0845
Practice Address - Fax:708-386-8472
Is Sole Proprietor?:No
Enumeration Date:2005-07-13
Last Update Date:2008-09-26
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OH04460176B00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes176B00000XOther Service ProvidersMidwife
Provider Identifiers
StateIdentifier IDID TypeIssuer
OH75541OtherUNSPECIFIED
OH2075409Medicaid
OH65006Medicare UPIN