Basic Information
| Provider Information | |||||||||
| NPI: | 1356747760 | ||||||||
| EntityType: | 1 | ||||||||
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| OrganizationName: | |||||||||
| LastName: | SCHREINER | ||||||||
| FirstName: | JENNA | ||||||||
| MiddleName: | MICHELLE | ||||||||
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| Credential: | PA-C | ||||||||
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| Mailing Information | |||||||||
| Address1: | 1 INDEPENDENCE PT | ||||||||
| Address2: | SUITE 212 | ||||||||
| City: | GREENVILLE | ||||||||
| State: | SC | ||||||||
| PostalCode: | 296154545 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 8647976044 | ||||||||
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| Practice Location | |||||||||
| Address1: | 106 PARKVIEW DR | ||||||||
| Address2: | |||||||||
| City: | LAURENS | ||||||||
| State: | SC | ||||||||
| PostalCode: | 293602652 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 8649840571 | ||||||||
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| Other Information | |||||||||
| ProviderEnumerationDate: | 11/12/2014 | ||||||||
| LastUpdateDate: | 03/31/2017 | ||||||||
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| ProviderGenderCode: | F | ||||||||
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| IsSoleProprietor: | N | ||||||||
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Taxonomy Information
| Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 363A00000X | PA 9108225 | FL | N | Physician Assistants & Advanced Practice Nursing Providers | Physician Assistant | 363A00000X | 2270 | SC | Y | Physician Assistants & Advanced Practice Nursing Providers | Physician Assistant | 363A00000X | 0010-06972 | NC | N | Physician Assistants & Advanced Practice Nursing Providers | Physician Assistant |
ID Information
| ID | Type | State | Issuer | Description | 003160192A | 05 | GA | MEDICAID | 2134PA | 05 | SC | MEDICAID |