Provider Demographics
NPI:1629356282
Name:SCHOMER, CHRISTINE JO (NP)
Entity Type:Individual
Prefix:MRS
First Name:CHRISTINE
Middle Name:JO
Last Name:SCHOMER
Suffix:
Gender:F
Credentials:NP
Other - Prefix:MS
Other - First Name:CHRISTINE
Other - Middle Name:JO
Other - Last Name:FONTANA
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:NP
Mailing Address - Street 1:43475 DALCOMA DR.
Mailing Address - Street 2:SUITE 150
Mailing Address - City:CLINTON TWP
Mailing Address - State:MI
Mailing Address - Zip Code:48038
Mailing Address - Country:US
Mailing Address - Phone:877-784-3667
Mailing Address - Fax:248-869-3968
Practice Address - Street 1:43475 DALCOMA DR
Practice Address - Street 2:STE. 150
Practice Address - City:CLINTON TWP
Practice Address - State:MI
Practice Address - Zip Code:48038
Practice Address - Country:US
Practice Address - Phone:877-784-3667
Practice Address - Fax:586-408-6071
Is Sole Proprietor?:No
Enumeration Date:2011-08-01
Last Update Date:2015-08-31
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MI4704234407363LF0000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LF0000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerFamily
Provider Identifiers
StateIdentifier IDID TypeIssuer
MIQ26462069Medicare PIN