Provider Demographics
NPI:1861266868
Name:SCHRAMEL, JENELLE MIRISSA
Entity type:Individual
Prefix:
First Name:JENELLE
Middle Name:MIRISSA
Last Name:SCHRAMEL
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:MIRISSA
Other - Middle Name:
Other - Last Name:SCHRAMEL
Other - Suffix:
Other - Last Name Type:Other Name
Other - Credentials:
Mailing Address - Street 1:776 S STATE ST STE 102
Mailing Address - Street 2:
Mailing Address - City:UKIAH
Mailing Address - State:CA
Mailing Address - Zip Code:95482-5847
Mailing Address - Country:US
Mailing Address - Phone:707-463-4915
Mailing Address - Fax:707-463-4917
Practice Address - Street 1:776 S STATE ST STE 102
Practice Address - Street 2:
Practice Address - City:UKIAH
Practice Address - State:CA
Practice Address - Zip Code:95482-5847
Practice Address - Country:US
Practice Address - Phone:707-463-4915
Practice Address - Fax:707-463-4917
Is Sole Proprietor?:No
Enumeration Date:2023-11-09
Last Update Date:2025-04-15
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
373H00000X
CA172V00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes373H00000XNursing Service Related ProvidersDay Training/Habilitation Specialist
No172V00000XOther Service ProvidersCommunity Health Worker