1891758736 NPI number — MRS. MONIQUE F SCHRADER MALPC

Table of content: MRS. MONIQUE F SCHRADER MALPC (NPI 1891758736)

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1891758736 NPI number — MRS. MONIQUE F SCHRADER MALPC

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
Provider Last Name:
SCHRADER
Provider First Name:
MONIQUE
Provider Middle Name:
F
Provider Name Prefix Text:
MRS.
Provider Name Suffix Text:
Provider Credential Text:
MALPC
Provider Gender Code:
F

Provider's Other Name Information

Provider Other Organization Name:
Provider Other Organization Name Type Code:
Provider Other Last Name:
FRAZIER
Provider Other First Name:
MONIQUE
Provider Other Middle Name:
Provider Other Name Prefix Text:
MS.
Provider Other Name Suffix Text:
Provider Other Credential Text:
MALPC
Provider Other Last Name Type Code:
1

NPI Number Information

NPI Number:
1891758736
Entity Type Code:
Individual
Replacement NPI:
Last Update Date:
07/13/2007
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
16942 HOLIDAY CIR
Provider Second Line Business Mailing Address:
Provider Business Mailing Address City Name:
BOONVILLE
Provider Business Mailing Address State Name:
MO
Provider Business Mailing Address Postal Code:
65233-3529
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
660-882-2333
Provider Business Mailing Address Fax Number:
660-882-2333

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
15899 LOGANS LAKE RD
Provider Second Line Business Practice Location Address:
Provider Business Practice Location Address City Name:
BOONVILLE
Provider Business Practice Location Address State Name:
MO
Provider Business Practice Location Address Postal Code:
65233-2866
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
660-882-2333
Provider Business Practice Location Address Fax Number:
660-882-2333
Provider Enumeration Date:
04/11/2006

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: 101Y00000X , with the licence number:  2005038682 , registered in the state of MO ; information, associated with the NPI states the following Primary Taxonomy Switch: "Y" .

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

  • Identifier: 1538204904 . This is a "BOONVILLE LOCATION NPI" identifier , issued by the state of ( MO ) . This identifiers is of the category "OTHER".
  • Identifier: 1649269622 . This is a "BILLING NPI" identifier , issued by the state of ( MO ) . This identifiers is of the category "OTHER".




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