Healthcare Provider Details

I. General information

NPI: 1336280387
Provider Name (Legal Business Name): MARCIA LEE SCHRADER NNP
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 02/11/2007
Last Update Date: 07/08/2007
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

615 S NEW BALLAS RD
SAINT LOUIS MO
63141-8221
US

IV. Provider business mailing address

1407 JAMISON ST
KIRKSVILLE MO
63501-3949
US

V. Phone/Fax

Practice location:
  • Phone: 314-251-6450
  • Fax:
Mailing address:
  • Phone: 660-627-8541
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code363LN0000X
TaxonomyNeonatal Nurse Practitioner
License Number2005021427
License Number StateMO

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: