Provider Demographics
NPI:1740436542
Name:SCHOCH, JENNIFER L (CRNP)
Entity type:Individual
Prefix:MS
First Name:JENNIFER
Middle Name:L
Last Name:SCHOCH
Suffix:
Gender:F
Credentials:CRNP
Other - Prefix:MS
Other - First Name:JENNIFER
Other - Middle Name:L
Other - Last Name:PHELPS
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:CRNP
Mailing Address - Street 1:132 MECHANIC ST
Mailing Address - Street 2:PO BOX 211
Mailing Address - City:SPARTANSBURG
Mailing Address - State:PA
Mailing Address - Zip Code:16434-1026
Mailing Address - Country:US
Mailing Address - Phone:814-654-7334
Mailing Address - Fax:814-654-7334
Practice Address - Street 1:132 MECHANIC ST
Practice Address - Street 2:
Practice Address - City:SPARTANSBURG
Practice Address - State:PA
Practice Address - Zip Code:16434-1026
Practice Address - Country:US
Practice Address - Phone:814-654-7334
Practice Address - Fax:814-654-7334
Is Sole Proprietor?:No
Enumeration Date:2008-08-12
Last Update Date:2011-11-15
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
PASP009888363L00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363L00000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse Practitioner
Provider Identifiers
StateIdentifier IDID TypeIssuer
PASP009888OtherLICENSE
OH135235FTGMedicare UPIN