MEDICARE: KATHERINE K SCHROEDER P.A.

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	2084P0015X	Psychosomatic Medicine Physician	11282	MN
2	364SF0001X	Family Health Clinical Nurse Specialist	11282	MN
3	364SH1100X	Holistic Clinical Nurse Specialist	11282	MN
4	364SP0809X	Adult Psychiatric/Mental Health Clinical Nurse Specialist	11282	MN
5	363AM0700X	Medical Physician Assistant	11282	MN

Other Identifiers

#	Provider Identifier	Provider Identifier Type	Provider Identifier State	Provider Identifier Issuer
1	11282	OTHER	MN	STATE LICENSE

General Provider Information

NPI Number	:	1215267927
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	KATHERINE K SCHROEDER P.A.

Provider Business Mailing Address
First Line	:	5821 CEDAR LAKE RD S STE 203
Second Line	:
City	:	SAINT LOUIS PARK
State	:	MN
Zip	:	55416-1487
Country	:	US
Telephone Number	:	612-293-0352
Fax Number	:	612-464-7879

Provider Business Practice Location Address
First Line	:	5821 CEDAR LAKE RD S STE 203
Second Line	:
City	:	SAINT LOUIS PARK
State	:	MN
Zip	:	55416-1487
Country	:	US
Telephone Number	:	612-293-0352
Fax Number	:

Authorized Official
Title or Position	:
Name	:
Credential	:
Telephone Number	:

Provider Enumeration Date	:	12/31/2009
Last Update Date	:	09/18/2023

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