Provider Demographics
NPI:1720491442
Name:SCHANEN, PETER JOHN (FNP, ENP)
Entity Type:Individual
Prefix:DR
First Name:PETER
Middle Name:JOHN
Last Name:SCHANEN
Suffix:
Gender:M
Credentials:FNP, ENP
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:PO BOX 1678
Mailing Address - Street 2:
Mailing Address - City:HELOTES
Mailing Address - State:TX
Mailing Address - Zip Code:78023-1678
Mailing Address - Country:US
Mailing Address - Phone:210-455-6253
Mailing Address - Fax:210-455-6287
Practice Address - Street 1:9910 W LOOP 1604 N STE 128
Practice Address - Street 2:
Practice Address - City:SAN ANTONIO
Practice Address - State:TX
Practice Address - Zip Code:78254-5610
Practice Address - Country:US
Practice Address - Phone:210-455-6253
Practice Address - Fax:210-455-6287
Is Sole Proprietor?:Yes
Enumeration Date:2014-06-10
Last Update Date:2024-01-25
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TXAP127362363LF0000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LF0000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerFamily
Provider Identifiers
StateIdentifier IDID TypeIssuer
TX344227910Medicaid