Provider Demographics
NPI:1770546731
Name:SCHENNE, JENNIFER B (DO)
Entity type:Individual
Prefix:
First Name:JENNIFER
Middle Name:B
Last Name:SCHENNE
Suffix:
Gender:F
Credentials:DO
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 31235
Mailing Address - Street 2:
Mailing Address - City:TUCSON
Mailing Address - State:AZ
Mailing Address - Zip Code:85751-1235
Mailing Address - Country:US
Mailing Address - Phone:520-324-2308
Mailing Address - Fax:520-324-1406
Practice Address - Street 1:10350 E DREXEL RD UNIT 110
Practice Address - Street 2:
Practice Address - City:TUCSON
Practice Address - State:AZ
Practice Address - Zip Code:85747-9409
Practice Address - Country:US
Practice Address - Phone:520-324-1727
Practice Address - Fax:520-324-1700
Is Sole Proprietor?:No
Enumeration Date:2006-04-10
Last Update Date:2023-12-01
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IA3653207Q00000X
AZ007191207Q00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207Q00000XAllopathic & Osteopathic PhysiciansFamily Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
AZ254505Medicaid
AZZ202456OtherMEDICARE PTAN
AZ007191OtherARIZONA LICENSE
AZZ202456OtherMEDICARE PTAN
IA0477836Medicaid