Provider Demographics
NPI:1427788843
Name:SCHANTZ, JACKIE J (NP-C)
Entity type:Individual
Prefix:MRS
First Name:JACKIE
Middle Name:J
Last Name:SCHANTZ
Suffix:
Gender:F
Credentials:NP-C
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:902 Q RD
Mailing Address - Street 2:
Mailing Address - City:WISNER
Mailing Address - State:NE
Mailing Address - Zip Code:68791-3562
Mailing Address - Country:US
Mailing Address - Phone:402-380-4569
Mailing Address - Fax:
Practice Address - Street 1:1800 SYRACUSE AVE
Practice Address - Street 2:
Practice Address - City:NORFOLK
Practice Address - State:NE
Practice Address - Zip Code:68701-2458
Practice Address - Country:US
Practice Address - Phone:402-371-8780
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2022-06-16
Last Update Date:2022-06-16
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NE114219363LF0000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LF0000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerFamily