Healthcare Provider Details

I. General information

NPI: 1790262525
Provider Name (Legal Business Name): ERIN ELIZABETH SCHROEDER PA-C
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

Provider Other Name: ERIN ELIZABETH GALLO

II. Dates (important events)

Enumeration Date: 07/24/2018
Last Update Date: 12/15/2025
Certification Date: 12/15/2025
Deactivation Date:
Reactivation Date:

III. Provider practice location address

2705 N LEBANON ST STE 210
LEBANON IN
46052-8622
US

IV. Provider business mailing address

2705 N LEBANON ST STE 305
LEBANON IN
46052-8622
US

V. Phone/Fax

Practice location:
  • Phone: 765-485-8790
  • Fax: 765-485-8795
Mailing address:
  • Phone: 765-485-8852
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code363A00000X
TaxonomyPhysician Assistant
License Number10002559A
License Number StateIN
# 2
Primary TaxonomyY
Taxonomy Code363AM0700X
TaxonomyMedical Physician Assistant
License Number10002599A
License Number StateIN

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: