Healthcare Provider Details

I. General information

NPI: 1841966645
Provider Name (Legal Business Name): ASHLEY NICHOLE SCHRADER CRNP
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 08/20/2021
Last Update Date: 08/20/2021
Certification Date: 08/20/2021
Deactivation Date:
Reactivation Date:

III. Provider practice location address

959 WYOMING AVE
SCRANTON PA
18509-3023
US

IV. Provider business mailing address

112 WINDSOR WAY
ROARING BROOK TWP PA
18444-9629
US

V. Phone/Fax

Practice location:
  • Phone: 570-344-9684
  • Fax:
Mailing address:
  • Phone: 570-309-4966
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code363LF0000X
TaxonomyFamily Nurse Practitioner
License NumberSP024274
License Number StatePA

VII. Legacy identifiers

For crosswalk purposes, the following legacy (non-NPI) identifiers are available for this provider:

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: