Healthcare Provider Details

I. General information

NPI: 1528574662
Provider Name (Legal Business Name): EMILY ALEXANDRA SCHRODEK
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 12/27/2017
Last Update Date: 08/09/2023
Certification Date: 08/09/2023
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1103 N B ST
SACRAMENTO CA
95811-0326
US

IV. Provider business mailing address

1103 N B ST
SACRAMENTO CA
95811-0326
US

V. Phone/Fax

Practice location:
  • Phone: 916-378-8266
  • Fax:
Mailing address:
  • Phone: 916-378-8266
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code163WP0807X
TaxonomyChild & Adolescent Psychiatric/Mental Health Registered Nurse
License Number95137966
License Number StateCA
# 2
Primary TaxonomyY
Taxonomy Code363LP0808X
TaxonomyPsychiatric/Mental Health Nurse Practitioner
License Number95012958
License Number StateCA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: