MEDICARE: TRACI SCHROEDER

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	163W00000X	Registered Nurse	4704300665	MI

General Provider Information

NPI Number	:	1174082721
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	TRACI SCHROEDER

Provider Business Mailing Address
First Line	:	4034 LESTER DR NE
Second Line	:
City	:	GRAND RAPIDS
State	:	MI
Zip	:	49525-1447
Country	:	US
Telephone Number	:
Fax Number	:

Provider Business Practice Location Address
First Line	:	4034 LESTER DR NE
Second Line	:
City	:	GRAND RAPIDS
State	:	MI
Zip	:	49525-1447
Country	:	US
Telephone Number	:	616-726-3688
Fax Number	:

Authorized Official
Title or Position	:
Name	:
Credential	:
Telephone Number	:

Provider Enumeration Date	:	03/13/2019
Last Update Date	:	10/11/2019

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Directions to “ TRACI SCHROEDER ” Practice Location

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