Healthcare Provider Details

I. General information

NPI: 1548305006
Provider Name (Legal Business Name): RYAN DAVID SCHROEDER RN
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 02/21/2007
Last Update Date: 07/08/2007
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

BLDG 166 4TH ST
FT. IRWIN CA
92310-5109
US

IV. Provider business mailing address

PO BOX 13210
FORT IRWIN CA
92310-5109
US

V. Phone/Fax

Practice location:
  • Phone: 760-380-3114
  • Fax:
Mailing address:
  • Phone: 253-678-9258
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code163W00000X
TaxonomyRegistered Nurse
License NumberRN00168934
License Number StateWA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: