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NPI Code Detail

MEDICARE: MRS. ELIZABETH MARY SCHROEDER RD, LD

MEDICARE: MRS. ELIZABETH MARY SCHROEDER RD, LD
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
1133V00000XRegistered Dietitian1490OK

General Provider Information

NPI Number : 1427179209
Entity Type Code : Individual
Provider Name (Legal Business Name) : MRS. ELIZABETH MARY SCHROEDER RD, LD
Provider Business Mailing Address
First Line : PO BOX 823
Second Line :
City : OKARCHE
State : OK
Zip : 73762-0823
Country : US
Telephone Number : 405-317-3020
Fax Number :
Provider Business Practice Location Address
First Line : 700 NW 7TH ST
Second Line :
City : OKLAHOMA CITY
State : OK
Zip : 73102-1212
Country : US
Telephone Number : 405-553-1481
Fax Number :
Authorized Official
Title or Position :
Name :
Credential :
Telephone Number :
Provider Enumeration Date : 04/02/2007
Last Update Date : 09/19/2007

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