Basic Information
Provider Information | |||||||||
NPI: | 1124007745 | ||||||||
EntityType: | 1 | ||||||||
ReplacementNPI: |   | ||||||||
OrganizationName: |   | ||||||||
LastName: | SCHER | ||||||||
FirstName: | JACQUELINE | ||||||||
MiddleName: | A. | ||||||||
NamePrefix: |   | ||||||||
NameSuffix: |   | ||||||||
Credential: | NP | ||||||||
OtherOrganizationName: |   | ||||||||
OtherOrganizationType: |   | ||||||||
OtherLastName: |   | ||||||||
OtherFirstName: |   | ||||||||
OtherMiddleName: |   | ||||||||
OtherNamePrefix: |   | ||||||||
OtherNameSuffix: |   | ||||||||
OtherCredential: |   | ||||||||
OtherLastNameType: |   | ||||||||
Mailing Information | |||||||||
Address1: | 6920 POINTE INVERNESS WAY STE 200 | ||||||||
Address2: | MEDPARTNERS, ATTN: BARB COPELAND | ||||||||
City: | FORT WAYNE | ||||||||
State: | IN | ||||||||
PostalCode: | 468047934 | ||||||||
CountryCode: | US | ||||||||
TelephoneNumber: | 2604793514 | ||||||||
FaxNumber: | 2604793520 | ||||||||
Practice Location | |||||||||
Address1: | 7916 W JEFFERSON BLVD | ||||||||
Address2: |   | ||||||||
City: | FORT WAYNE | ||||||||
State: | IN | ||||||||
PostalCode: | 468044140 | ||||||||
CountryCode: | US | ||||||||
TelephoneNumber: | 2604322297 | ||||||||
FaxNumber: | 2604346496 | ||||||||
Other Information | |||||||||
ProviderEnumerationDate: | 01/12/2006 | ||||||||
LastUpdateDate: | 01/03/2017 | ||||||||
NPIDeactivationReasonCode: |   | ||||||||
NPIDeactivationDate: |   | ||||||||
NPIReactivationDate: |   | ||||||||
ProviderGenderCode: | F | ||||||||
AuthorizedOfficialLastName: |   | ||||||||
AuthorizedOfficialFirstName: |   | ||||||||
AuthorizedOfficialMiddleName: |   | ||||||||
AuthorizedOfficialTitleorPosition: |   | ||||||||
AuthorizedOfficialTelephone: |   | ||||||||
IsSoleProprietor: | N | ||||||||
IsOrganizationSubpart: |   | ||||||||
ParentOrganizationLBN: |   | ||||||||
AuthorizedOfficialNamePrefix: |   | ||||||||
AuthorizedOfficialNameSuffix: |   | ||||||||
AuthorizedOfficialCredential: |   | ||||||||
NPICertificationDate: |   |
Taxonomy Information
Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 363L00000X | 71000541A | IN | Y |   | Physician Assistants & Advanced Practice Nursing Providers | Nurse Practitioner |   |
ID Information
ID | Type | State | Issuer | Description | P00805819 | 01 | IN | RAILROAD MEDICARE | OTHER | 200296740 | 05 | IN |   | MEDICAID | P00400740 | 01 | OH | MEDICARE - RAILROAD | OTHER | 10870 | 01 | IN | PHP | OTHER | 000000497491 | 01 | IN | ANTHEM | OTHER | 2731860 | 05 | OH |   | MEDICAID |