1265484703 NPI number — STELLA RENEE SCHROEDER CRNA

Table of content: STELLA RENEE SCHROEDER CRNA (NPI 1265484703)

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1265484703 NPI number — STELLA RENEE SCHROEDER CRNA

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
Provider Last Name:
SCHROEDER
Provider First Name:
STELLA
Provider Middle Name:
RENEE
Provider Name Prefix Text:
Provider Name Suffix Text:
Provider Credential Text:
CRNA
Provider Gender Code:
F

Provider's Other Name Information

Provider Other Organization Name:
Provider Other Organization Name Type Code:
Provider Other Last Name:
SCHROEDER
Provider Other First Name:
S
Provider Other Middle Name:
RENEE
Provider Other Name Prefix Text:
Provider Other Name Suffix Text:
Provider Other Credential Text:
CRNA
Provider Other Last Name Type Code:
5

NPI Number Information

NPI Number:
1265484703
Entity Type Code:
Individual
Replacement NPI:
Last Update Date:
05/17/2010
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
190 N UNION ST
Provider Second Line Business Mailing Address:
STE 104
Provider Business Mailing Address City Name:
AKRON
Provider Business Mailing Address State Name:
OH
Provider Business Mailing Address Postal Code:
44304-1369
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
330-253-9145
Provider Business Mailing Address Fax Number:
330-253-6222

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
190 N UNION ST
Provider Second Line Business Practice Location Address:
STE 104
Provider Business Practice Location Address City Name:
AKRON
Provider Business Practice Location Address State Name:
OH
Provider Business Practice Location Address Postal Code:
44304-1369
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
330-253-9145
Provider Business Practice Location Address Fax Number:
330-253-6222
Provider Enumeration Date:
05/16/2006

Additional Information

Authorized Official

Authorized Official Last Name:
Authorized Official First Name:
Authorized Official Middle Name:
Authorized Official Title or Position:
Authorized Official Telephone Number:

Provider Taxonomy Codes

  • Taxonomy code: 367500000X , with the licence number:  RN-172166 , registered in the state of OH ; information, associated with the NPI states the following Primary Taxonomy Switch: "Y" .

Other Provider's Identifiers (legacy, non-NPI)

  • Identifier: 000000125739 . This is a "ANTHEM BCBS INDV NUMBER" identifier , issued by the state of ( OH ) . This identifiers is of the category "OTHER".
  • Identifier: 7091249 , issued by the state of ( OH ) . This identifiers is of the category "MEDICAID".
  • Identifier: 120793 . This is a "KAISER PERMANENTE INDV #" identifier , issued by the state of ( OH ) . This identifiers is of the category "OTHER".
  • Identifier: 100153 . This is a "EMPLOYER KAISER GROUP #" identifier , issued by the state of ( OH ) . This identifiers is of the category "OTHER".
  • Identifier: 2080224 . This is a "EMP UNITED HEALTHCARE GRP" identifier , issued by the state of ( OH ) . This identifiers is of the category "OTHER".
  • Identifier: 0996034 , issued by the state of ( OH ) . This identifiers is of the category "MEDICAID".
  • Identifier: 34-0891295 . This is a "EMPLOYER FEDERAL TAX ID #" identifier , issued by the state of ( OH ) . This identifiers is of the category "OTHER".
  • Identifier: 730605 . This is a "BUCKEYE COMMUNITY HLTH PL" identifier , issued by the state of ( OH ) . This identifiers is of the category "OTHER".




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