Provider Demographics
NPI:1386951358
Name:SCHOENECKER, JODY MICHELLE (CNP)
Entity type:Individual
Prefix:MRS
First Name:JODY
Middle Name:MICHELLE
Last Name:SCHOENECKER
Suffix:
Gender:F
Credentials:CNP
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
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Other - Credentials:
Mailing Address - Street 1:615 1ST AVE NE STE 310
Mailing Address - Street 2:
Mailing Address - City:MINNEAPOLIS
Mailing Address - State:MN
Mailing Address - Zip Code:55413-2419
Mailing Address - Country:US
Mailing Address - Phone:612-436-0295
Mailing Address - Fax:612-436-0163
Practice Address - Street 1:615 1ST AVE NE STE 310
Practice Address - Street 2:
Practice Address - City:MINNEAPOLIS
Practice Address - State:MN
Practice Address - Zip Code:55413-2419
Practice Address - Country:US
Practice Address - Phone:612-436-0295
Practice Address - Fax:612-436-0163
Is Sole Proprietor?:Yes
Enumeration Date:2010-09-10
Last Update Date:2020-11-10
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MN1241826363L00000X
MN2010008194363LP0808X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LP0808XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerPsychiatric/Mental Health
No363L00000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse Practitioner