Basic Information
Provider Information
NPI: 1306360383
EntityType: 1
ReplacementNPI:  
OrganizationName:  
LastName: SCHNIEPP
FirstName: ANNE
MiddleName: E
NamePrefix:  
NameSuffix:  
Credential: NP
OtherOrganizationName:  
OtherOrganizationType:  
OtherLastName:  
OtherFirstName:  
OtherMiddleName:  
OtherNamePrefix:  
OtherNameSuffix:  
OtherCredential:  
OtherLastNameType:  
Mailing Information
Address1: 2300 N EDWARD ST
Address2: BUSINESS OFFICE
City: DECATUR
State: IL
PostalCode: 62526
CountryCode: US
TelephoneNumber: 2178762857
FaxNumber: 2178762249
Practice Location
Address1: 241 W WEAVER RD STE 145C
Address2:  
City: FORSYTH
State: IL
PostalCode: 625359767
CountryCode: US
TelephoneNumber: 2178765200
FaxNumber: 2178765206
Other Information
ProviderEnumerationDate: 08/01/2017
LastUpdateDate: 08/01/2017
NPIDeactivationReasonCode:  
NPIDeactivationDate:  
NPIReactivationDate:  
ProviderGenderCode: F
AuthorizedOfficialLastName:  
AuthorizedOfficialFirstName:  
AuthorizedOfficialMiddleName:  
AuthorizedOfficialTitleorPosition:  
AuthorizedOfficialTelephone:  
IsSoleProprietor: N
IsOrganizationSubpart:  
ParentOrganizationLBN:  
AuthorizedOfficialNamePrefix:  
AuthorizedOfficialNameSuffix:  
AuthorizedOfficialCredential:  
NPICertificationDate:  

Taxonomy Information
TaxonomyLicenseStateSwitchTaxonomyGroupTaxonomyTypeTaxonomyClassSubSpecialty
363LF0000X209016125ILY Physician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerFamily

No ID Information.


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