Healthcare Provider Details

I. General information

NPI: 1720580160
Provider Name (Legal Business Name): DANA JANINE SCHROEDER NP
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 03/01/2018
Last Update Date: 03/17/2018
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

2425 SAMARITAN DR
SAN JOSE CA
95124-3908
US

IV. Provider business mailing address

19341 OVERLOOK RD
LOS GATOS CA
95030-4183
US

V. Phone/Fax

Practice location:
  • Phone: 408-559-2514
  • Fax:
Mailing address:
  • Phone: 408-307-2890
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code363LP2300X
TaxonomyPrimary Care Nurse Practitioner
License Number95006626
License Number StateCA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: