Healthcare Provider Details

I. General information

NPI: 1558802090
Provider Name (Legal Business Name): CHRISTINE SCHRADER
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 03/16/2017
Last Update Date: 03/16/2017
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

7368 TOURNAMENT DR
SAINT LOUIS MO
63129-7707
US

IV. Provider business mailing address

7368 TOURNAMENT DR
SAINT LOUIS MO
63129-7707
US

V. Phone/Fax

Practice location:
  • Phone: 636-627-7196
  • Fax:
Mailing address:
  • Phone: 636-627-7196
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code174N00000X
TaxonomyLactation Consultant (Non-RN)
License Number231197
License Number StateMO

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: