1184221475 NPI number — DR. LAURAN SCHROEDER DPT

Table of content: DR. LAURAN SCHROEDER DPT (NPI 1184221475)

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1184221475 NPI number — DR. LAURAN SCHROEDER DPT

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
Provider Last Name:
SCHROEDER
Provider First Name:
LAURAN
Provider Middle Name:
Provider Name Prefix Text:
DR.
Provider Name Suffix Text:
Provider Credential Text:
DPT
Provider Gender Code:
F

Provider's Other Name Information

Provider Other Organization Name:
Provider Other Organization Name Type Code:
Provider Other Last Name:
HELLBUSCH
Provider Other First Name:
LAURAN
Provider Other Middle Name:
Provider Other Name Prefix Text:
DR.
Provider Other Name Suffix Text:
Provider Other Credential Text:
DPT
Provider Other Last Name Type Code:
1

NPI Number Information

NPI Number:
1184221475
Entity Type Code:
Individual
Replacement NPI:
Last Update Date:
02/17/2025
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
9070 W CHEYENNE AVE STE 100
Provider Second Line Business Mailing Address:
Provider Business Mailing Address City Name:
LAS VEGAS
Provider Business Mailing Address State Name:
NV
Provider Business Mailing Address Postal Code:
89129-8935
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
702-818-5000
Provider Business Mailing Address Fax Number:
702-818-5001

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
801 SUMMIT ST
Provider Second Line Business Practice Location Address:
Provider Business Practice Location Address City Name:
YANKTON
Provider Business Practice Location Address State Name:
SD
Provider Business Practice Location Address Postal Code:
57078-3338
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
605-665-3861
Provider Business Practice Location Address Fax Number:
605-665-3866
Provider Enumeration Date:
10/08/2020

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: 225100000X , with the licence number:  2395 , registered in the state of SD ; information, associated with the NPI states the following Primary Taxonomy Switch: "Y" .

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