Provider Demographics
NPI:1982025680
Name:SCHROETTER, SHANNON JO (CPNP-AC)
Entity Type:Individual
Prefix:MRS
First Name:SHANNON
Middle Name:JO
Last Name:SCHROETTER
Suffix:
Gender:F
Credentials:CPNP-AC
Other - Prefix:MS
Other - First Name:SHANNON
Other - Middle Name:JO
Other - Last Name:MCDONNELL
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:
Mailing Address - Street 1:200 HAWKINS DR
Mailing Address - Street 2:
Mailing Address - City:IOWA CITY
Mailing Address - State:IA
Mailing Address - Zip Code:52242-1009
Mailing Address - Country:US
Mailing Address - Phone:319-356-7825
Mailing Address - Fax:319-384-6295
Practice Address - Street 1:200 HAWKINS DR
Practice Address - Street 2:
Practice Address - City:IOWA CITY
Practice Address - State:IA
Practice Address - Zip Code:52242
Practice Address - Country:US
Practice Address - Phone:319-356-7825
Practice Address - Fax:319-384-6295
Is Sole Proprietor?:No
Enumeration Date:2013-12-23
Last Update Date:2019-09-05
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IAC154146363L00000X, 363LA2100X, 363LP0200X
MNR 217536-0363LP0200X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LP0200XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerPediatrics
No363L00000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse Practitioner
No363LA2100XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerAcute Care