Healthcare Provider Details

I. General information

NPI: 1780780080
Provider Name (Legal Business Name): MARIANNE T SCHROEDER PA
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 09/15/2006
Last Update Date: 07/09/2007
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

WCA HOSPITAL, 207 FOOTE AVE
JAMESTOWN NY
14701
US

IV. Provider business mailing address

PO BOX 1258
JAMESTOWN NY
14702-1258
US

V. Phone/Fax

Practice location:
  • Phone: 716-487-0141
  • Fax:
Mailing address:
  • Phone: 716-487-1124
  • Fax: 716-487-2488

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code363A00000X
TaxonomyPhysician Assistant
License Number011473
License Number StateNY

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: