Provider Demographics
NPI:1336274042
Name:SCHOPEN, JANE RITA (PA-C)
Entity Type:Individual
Prefix:
First Name:JANE
Middle Name:RITA
Last Name:SCHOPEN
Suffix:
Gender:F
Credentials:PA-C
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1945 MESQUITE AVE
Mailing Address - Street 2:SUITE B
Mailing Address - City:LAKE HAVASU CITY
Mailing Address - State:AZ
Mailing Address - Zip Code:86403-5889
Mailing Address - Country:US
Mailing Address - Phone:928-855-7773
Mailing Address - Fax:928-855-0532
Practice Address - Street 1:1945 MESQUITE AVE
Practice Address - Street 2:SUITE B
Practice Address - City:LAKE HAVASU CITY
Practice Address - State:AZ
Practice Address - Zip Code:86403-5889
Practice Address - Country:US
Practice Address - Phone:928-855-7773
Practice Address - Fax:928-855-0532
Is Sole Proprietor?:Yes
Enumeration Date:2007-02-22
Last Update Date:2007-07-09
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
AZ1976363AM0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363AM0700XPhysician Assistants & Advanced Practice Nursing ProvidersPhysician AssistantMedical
Provider Identifiers
StateIdentifier IDID TypeIssuer
AZ348343Medicaid