Healthcare Provider Details

I. General information

NPI: 1700184009
Provider Name (Legal Business Name): MARY C SCHROEDER PMHCNS
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 03/10/2011
Last Update Date: 03/10/2011
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

4040 W 86TH ST
INDIANAPOLIS IN
46268-7800
US

IV. Provider business mailing address

8816 HOLLIDAY DR
INDIANAPOLIS IN
46260-1706
US

V. Phone/Fax

Practice location:
  • Phone: 317-876-3699
  • Fax: 317-876-3600
Mailing address:
  • Phone: 317-218-3602
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code364SP0809X
TaxonomyAdult Psychiatric/Mental Health Clinical Nurse Specialist
License Number28070089A
License Number StateIN

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: