Provider Demographics
NPI:1679756910
Name:SCHROEDER, JO ANN (CNP)
Entity type:Individual
Prefix:
First Name:JO
Middle Name:ANN
Last Name:SCHROEDER
Suffix:
Gender:F
Credentials:CNP
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:49TH MEDICAL GROUP/SGPF
Mailing Address - Street 2:280 FIRST STREET, BLDG 23
Mailing Address - City:HOLLOMAN AFB
Mailing Address - State:NM
Mailing Address - Zip Code:88330-8273
Mailing Address - Country:US
Mailing Address - Phone:575-572-4889
Mailing Address - Fax:575-572-2259
Practice Address - Street 1:49TH MEDICAL GROUP/SGPF
Practice Address - Street 2:280 FIRST ST BLDG 23
Practice Address - City:HOLLOMAN AFB
Practice Address - State:NM
Practice Address - Zip Code:88330-8273
Practice Address - Country:US
Practice Address - Phone:575-572-4889
Practice Address - Fax:575-572-2259
Is Sole Proprietor?:No
Enumeration Date:2007-12-10
Last Update Date:2018-06-16
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NMR57915363L00000X
NMCNP01373363LA2200X, 363LP2300X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LP2300XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerPrimary Care
No363L00000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse Practitioner
No363LA2200XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerAdult Health