Provider Demographics
NPI:1710015680
Name:SCHROEDER, JAN MARIE (CNP)
Entity Type:Individual
Prefix:
First Name:JAN
Middle Name:MARIE
Last Name:SCHROEDER
Suffix:
Gender:F
Credentials:CNP
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:3224 JARVIS RD
Mailing Address - Street 2:
Mailing Address - City:LIMA
Mailing Address - State:OH
Mailing Address - Zip Code:45807-2213
Mailing Address - Country:US
Mailing Address - Phone:419-996-5757
Mailing Address - Fax:419-996-5913
Practice Address - Street 1:3224 JARVIS RD
Practice Address - Street 2:
Practice Address - City:LIMA
Practice Address - State:OH
Practice Address - Zip Code:45807-2213
Practice Address - Country:US
Practice Address - Phone:419-996-5757
Practice Address - Fax:419-996-5913
Is Sole Proprietor?:No
Enumeration Date:2007-03-01
Last Update Date:2023-08-15
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OH09021363LF0000X
OHAPRN.CNP.09021363LF0000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LF0000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerFamily
Provider Identifiers
StateIdentifier IDID TypeIssuer
OH2759626Medicaid
OHNP84161Medicare PIN