Individual
JENNIFER L SCHOTTLEUTNER
Active
Sole proprietor
No
Provider details
NPI number
Gender
F
Credential
PA
Contact information
Practice address
853 N CHURCH ST, SUITE 410A, SPARTANBURG, SC 29303-3040
(864) 560-6928
(864) 560-4413
Mailing address
PO BOX 2168, SPARTANBURG, SC 29304-2168
(864) 560-4304
(864) 560-4123
Taxonomy
Speciality
Code
Description
License number
State
363A00000X
Physician Assistant
Primary
1408
SC
363A00000X
Physician Assistant
—
—
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
0794PA
—
SC
01
—
P00761341
RAILROAD MEDICARE
SC
Enumeration date
03/23/2009
Last updated
12/10/2009
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