Provider Demographics
NPI:1205864576
Name:JENSEN SCHNEIDER, MELEAH R (PA-C)
Entity type:Individual
Prefix:
First Name:MELEAH
Middle Name:R
Last Name:JENSEN SCHNEIDER
Suffix:
Gender:F
Credentials:PA-C
Other - Prefix:
Other - First Name:MELEAH
Other - Middle Name:R
Other - Last Name:JENSEN
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:PA-C
Mailing Address - Street 1:1195 HIGHWAY T47
Mailing Address - Street 2:
Mailing Address - City:GLADBROOK
Mailing Address - State:IA
Mailing Address - Zip Code:50635-9368
Mailing Address - Country:US
Mailing Address - Phone:555-555-5555
Mailing Address - Fax:
Practice Address - Street 1:1195 HIGHWAY T47
Practice Address - Street 2:
Practice Address - City:GLADBROOK
Practice Address - State:IA
Practice Address - Zip Code:50635-9368
Practice Address - Country:US
Practice Address - Phone:555-555-5555
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2006-06-28
Last Update Date:2025-01-27
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IA001648363A00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363A00000XPhysician Assistants & Advanced Practice Nursing ProvidersPhysician Assistant
Provider Identifiers
StateIdentifier IDID TypeIssuer
IAP01091014OtherRR MEDICARE
IAQ52411Medicare UPIN
IAI16015Medicare ID - Type Unspecified