Healthcare Provider Details

I. General information

NPI: 1730645888
Provider Name (Legal Business Name): REBECCA LIND SCHRADER FNP
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 02/13/2019
Last Update Date: 02/13/2019
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

3746 FOSTER LANE NW
WESSON MS
39191
US

IV. Provider business mailing address

3746 FOSTER LANE NW
WESSON MS
39191
US

V. Phone/Fax

Practice location:
  • Phone: 601-833-4507
  • Fax:
Mailing address:
  • Phone: 601-833-4507
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code363L00000X
TaxonomyNurse Practitioner
License Number903112
License Number StateMS

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: