Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
N | 208000000X | Pediatrician | 267163 | MA |
Y | 2080P0202X | Pediatric Cardiologist | MD60938671 | WA |
NPI | 1134575046 |
---|---|
Provider Name | Jenna Suzanne Schauer |
First Address | Boston, MA 02114 |
Second Address | Seattle, WA 98105-3901 |
Gender | F |
NPI Entity type | Individual |
Is Sole Proprietor | No |
Is Organization Subpart | N/A |
Enumeration Date | 10/05/2016 |
Last Update Date | 01/11/2019 |