Provider Demographics
NPI:1952613028
Name:SHOEMAKER, JENNIFER MONIQUE (MD)
Entity Type:Individual
Prefix:MS
First Name:JENNIFER
Middle Name:MONIQUE
Last Name:SHOEMAKER
Suffix:
Gender:F
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
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Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:10470 OLD PLACERVILLE RD STE 100
Mailing Address - Street 2:
Mailing Address - City:SACRAMENTO
Mailing Address - State:CA
Mailing Address - Zip Code:95827-2539
Mailing Address - Country:US
Mailing Address - Phone:800-470-0071
Mailing Address - Fax:
Practice Address - Street 1:815 COURT ST STE 7
Practice Address - Street 2:
Practice Address - City:JACKSON
Practice Address - State:CA
Practice Address - Zip Code:95642-2154
Practice Address - Country:US
Practice Address - Phone:209-223-2034
Practice Address - Fax:209-223-2038
Is Sole Proprietor?:No
Enumeration Date:2010-07-06
Last Update Date:2019-02-21
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CAA135203207Q00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207Q00000XAllopathic & Osteopathic PhysiciansFamily Medicine