Provider Demographics
NPI:1760933956
Name:SCHMITZ, JEANALYN SUBIDO (AGNP)
Entity Type:Individual
Prefix:MS
First Name:JEANALYN
Middle Name:SUBIDO
Last Name:SCHMITZ
Suffix:
Gender:F
Credentials:AGNP
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
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Other - Credentials:
Mailing Address - Street 1:PO BOX 505445
Mailing Address - Street 2:
Mailing Address - City:SAINT LOUIS
Mailing Address - State:MO
Mailing Address - Zip Code:63150-5445
Mailing Address - Country:US
Mailing Address - Phone:314-367-3113
Mailing Address - Fax:314-367-6491
Practice Address - Street 1:1110 HIGHLANDS PLAZA DR E
Practice Address - Street 2:STE 375
Practice Address - City:SAINT LOUIS
Practice Address - State:MO
Practice Address - Zip Code:63110-1392
Practice Address - Country:US
Practice Address - Phone:314-367-3113
Practice Address - Fax:314-367-6491
Is Sole Proprietor?:No
Enumeration Date:2016-10-22
Last Update Date:2024-05-09
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MO2017014479363LF0000X
MO2010009502163W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes163W00000XNursing Service ProvidersRegistered Nurse
Yes363LF0000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerFamily
Provider Identifiers
StateIdentifier IDID TypeIssuer
MO420048563Medicaid