MEDICARE: ELIZABETH A SHRADER DNP, MSN, APRN

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	363LX0001X	Obstetrics & Gynecology Nurse Practitioner	AP5059	AZ
2	363LP0808X	Psychiatric/Mental Health Nurse Practitioner	AP5059	AZ

General Provider Information

NPI Number	:	1497785489
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	ELIZABETH A SHRADER DNP, MSN, APRN

Provider Business Mailing Address
First Line	:	633 E RAY RD STE 114
Second Line	:
City	:	GILBERT
State	:	AZ
Zip	:	85296-4205
Country	:	US
Telephone Number	:	602-671-3091
Fax Number	:	602-563-8170

Provider Business Practice Location Address
First Line	:	633 E RAY RD STE 114
Second Line	:
City	:	GILBERT
State	:	AZ
Zip	:	85296-4205
Country	:	US
Telephone Number	:	602-671-3091
Fax Number	:	602-563-8170

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

Provider Enumeration Date	:	07/04/2006
Last Update Date	:	03/10/2026

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