=====================================================
General NPI Number Information
=====================================================
NPI Number | 1851941686
-----------------------------------------------------
Entity Type | Individual
-----------------------------------------------------
Provider Name | GLORIA EVELAN SCHROEDER
-----------------------------------------------------
Gender | Female
-----------------------------------------------------
=====================================================
Dates
=====================================================
Enumeration Date | 09/13/2019
-----------------------------------------------------
Last Update Date | 09/13/2019
-----------------------------------------------------
=====================================================
Provider Practice Location Address
=====================================================
Address Line | 117 N 1ST STREET
-----------------------------------------------------
City | CALEDONIA
-----------------------------------------------------
State | MN
-----------------------------------------------------
Zip | 55921
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 507-725-2826
-----------------------------------------------------
Fax |
-----------------------------------------------------
=====================================================
Provider Business Mailing Address
=====================================================
Address Line | 117 N 1ST STREET
-----------------------------------------------------
City | CALEDONIA
-----------------------------------------------------
State | MN
-----------------------------------------------------
Zip | 55921
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 507-725-2826
-----------------------------------------------------
Fax |
-----------------------------------------------------
=====================================================
Authorized Official
=====================================================
Title or Position |
-----------------------------------------------------
Name |
-----------------------------------------------------
Credential |
-----------------------------------------------------
Telephone |
-----------------------------------------------------
=====================================================
Scope of Practice (Provider's specialty)
=====================================================
Taxonomy #1
-----------------------------------------------------
Taxonomy Code | 3747A0650X
-----------------------------------------------------
Taxonomy Name | Attendant Care Provider
-----------------------------------------------------
License Number |
-----------------------------------------------------
License Number State |
-----------------------------------------------------