Provider Demographics
NPI:1740529858
Name:SCHNELL, JOHANNA ELLEN (PLA)
Entity type:Individual
Prefix:
First Name:JOHANNA
Middle Name:ELLEN
Last Name:SCHNELL
Suffix:
Gender:F
Credentials:PLA
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:30672 SUNNY BEACH RD
Mailing Address - Street 2:
Mailing Address - City:GRAND RAPIDS
Mailing Address - State:MN
Mailing Address - Zip Code:55744-4891
Mailing Address - Country:US
Mailing Address - Phone:319-360-7351
Mailing Address - Fax:
Practice Address - Street 1:30672 SUNNY BEACH RD
Practice Address - Street 2:
Practice Address - City:GRAND RAPIDS
Practice Address - State:MN
Practice Address - Zip Code:55744-4891
Practice Address - Country:US
Practice Address - Phone:319-360-7351
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2013-02-08
Last Update Date:2013-02-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes374J00000XNursing Service Related ProvidersDoulaGroup - Multi-Specialty
No174H00000XOther Service ProvidersHealth EducatorGroup - Multi-Specialty
No174N00000XOther Service ProvidersLactation Consultant, Non-RNGroup - Multi-Specialty