Provider Demographics
NPI:1689022089
Name:SCHRADER, PATRICIA DANIELLE (NP-C)
Entity type:Individual
Prefix:
First Name:PATRICIA
Middle Name:DANIELLE
Last Name:SCHRADER
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 1:621 S NEW BALLAS RD STE 5003B
Mailing Address - Street 2:
Mailing Address - City:SAINT LOUIS
Mailing Address - State:MO
Mailing Address - Zip Code:63141-8270
Mailing Address - Country:US
Mailing Address - Phone:314-251-8892
Mailing Address - Fax:
Practice Address - Street 1:621 S NEW BALLAS RD STE 5003B
Practice Address - Street 2:
Practice Address - City:SAINT LOUIS
Practice Address - State:MO
Practice Address - Zip Code:63141-8270
Practice Address - Country:US
Practice Address - Phone:314-251-8892
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2016-05-26
Last Update Date:2024-10-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MO2015032918363LA2200X
MO2011017712163W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LA2200XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerAdult Health
No163W00000XNursing Service ProvidersRegistered Nurse