Healthcare Provider Details

I. General information

NPI: 1598957110
Provider Name (Legal Business Name): DANIEL CHARLES SCHROEDER RN, PMHNP
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 08/16/2007
Last Update Date: 10/15/2014
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

21210 NW MAUZEY RD
HILLSBORO OR
97124-9327
US

IV. Provider business mailing address

PO BOX 82819
PORTLAND OR
97282-0819
US

V. Phone/Fax

Practice location:
  • Phone: 503-439-9531
  • Fax: 503-531-3841
Mailing address:
  • Phone: 503-233-5405
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code363LP0808X
TaxonomyPsychiatric/Mental Health Nurse Practitioner
License Number200850118NP
License Number StateOR
# 2
Primary TaxonomyN
Taxonomy Code163WP0809X
TaxonomyAdult Psychiatric/Mental Health Registered Nurse
License NumberRN00168895
License Number StateWA
# 3
Primary TaxonomyN
Taxonomy Code163WP0809X
TaxonomyAdult Psychiatric/Mental Health Registered Nurse
License Number200642744RN
License Number StateOR

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: