Healthcare Provider Details

I. General information

NPI: 1922347186
Provider Name (Legal Business Name): DERAE AUDRA SCHROEDER DNP, ARNP
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 02/07/2013
Last Update Date: 12/04/2013
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

513 S MUCKEY ST
MAPLETON IA
51034-1055
US

IV. Provider business mailing address

501 MELROSE ST P.O. BOX 432
WALL LAKE IA
51466-7598
US

V. Phone/Fax

Practice location:
  • Phone: 712-882-2234
  • Fax:
Mailing address:
  • Phone: 712-880-0222
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code363LF0000X
TaxonomyFamily Nurse Practitioner
License NumberF0712790
License Number StateIA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: