Healthcare Provider Details

I. General information

NPI: 1215267927
Provider Name (Legal Business Name): KATHERINE K SCHROEDER P.A.
Entity Type: Individual
Gender: Female
Sole Proprietor: N

Provider Other Name: KATHERINE STOESZ PA

II. Dates (important events)

Enumeration Date: 12/31/2009
Last Update Date: 09/18/2023
Certification Date: 09/18/2023
Deactivation Date:
Reactivation Date:

III. Provider practice location address

5821 CEDAR LAKE RD S STE 203
SAINT LOUIS PARK MN
55416-1487
US

IV. Provider business mailing address

5821 CEDAR LAKE RD S STE 203
SAINT LOUIS PARK MN
55416-1487
US

V. Phone/Fax

Practice location:
  • Phone: 612-293-0352
  • Fax:
Mailing address:
  • Phone: 612-293-0352
  • Fax: 612-464-7879

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code2084P0015X
TaxonomyPsychosomatic Medicine Physician
License Number11282
License Number StateMN
# 2
Primary TaxonomyN
Taxonomy Code364SF0001X
TaxonomyFamily Health Clinical Nurse Specialist
License Number11282
License Number StateMN
# 3
Primary TaxonomyN
Taxonomy Code364SH1100X
TaxonomyHolistic Clinical Nurse Specialist
License Number11282
License Number StateMN
# 4
Primary TaxonomyN
Taxonomy Code364SP0809X
TaxonomyAdult Psychiatric/Mental Health Clinical Nurse Specialist
License Number11282
License Number StateMN
# 5
Primary TaxonomyY
Taxonomy Code363AM0700X
TaxonomyMedical Physician Assistant
License Number11282
License Number StateMN

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: