Healthcare Provider Details

I. General information

NPI: 1720028053
Provider Name (Legal Business Name): DIANE SCHADEWALD CNP
Entity Type: Individual
Gender: Female
Sole Proprietor: X

II. Dates (important events)

Enumeration Date: 06/07/2006
Last Update Date: 09/11/2025
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

420 DELAWARE ST SE MMC 741
MINNEAPOLIS MN
55455
US

IV. Provider business mailing address

420 DELAWARE ST SE MMC 741
MINNEAPOLIS MN
55455
US

V. Phone/Fax

Practice location:
  • Phone: 612-624-9499
  • Fax:
Mailing address:
  • Phone: 612-624-9499
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code363L00000X
TaxonomyNurse Practitioner
License NumberR0812984
License Number StateMN
# 2
Primary TaxonomyN
Taxonomy Code363LF0000X
TaxonomyFamily Nurse Practitioner
License NumberR0812984
License Number StateMN
# 3
Primary TaxonomyY
Taxonomy Code363LW0102X
TaxonomyWomen's Health Nurse Practitioner
License NumberR0812984
License Number StateMN

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: