Provider Demographics
NPI:1730164757
Name:SCHNEPF, JILL D (CRNA)
Entity type:Individual
Prefix:
First Name:JILL
Middle Name:D
Last Name:SCHNEPF
Suffix:
Gender:F
Credentials:CRNA
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:PO BOX 20452
Mailing Address - Street 2:YPS-CRED
Mailing Address - City:COLUMBUS
Mailing Address - State:OH
Mailing Address - Zip Code:43220-0452
Mailing Address - Country:US
Mailing Address - Phone:614-442-2406
Mailing Address - Fax:
Practice Address - Street 1:304 S DAUGHERTY AVE
Practice Address - Street 2:ANESTHESIA DEPT.
Practice Address - City:EASTLAND
Practice Address - State:TX
Practice Address - Zip Code:76448-2609
Practice Address - Country:US
Practice Address - Phone:254-631-5339
Practice Address - Fax:254-629-8929
Is Sole Proprietor?:Yes
Enumeration Date:2005-12-13
Last Update Date:2014-10-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TXAP118264367500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes367500000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse Anesthetist, Certified Registered
Provider Identifiers
StateIdentifier IDID TypeIssuer
038493OtherCRNA RECERTIFICATION CARD