Provider Demographics
NPI:1063018109
Name:SCHROEDER, CARRIE ELLEN
Entity Type:Individual
Prefix:
First Name:CARRIE
Middle Name:ELLEN
Last Name:SCHROEDER
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:109 YESLER WAY
Mailing Address - Street 2:
Mailing Address - City:HILLSDALE
Mailing Address - State:NJ
Mailing Address - Zip Code:07642-2612
Mailing Address - Country:US
Mailing Address - Phone:201-362-8718
Mailing Address - Fax:
Practice Address - Street 1:5002 S CROATAN HWY STE B
Practice Address - Street 2:
Practice Address - City:NAGS HEAD
Practice Address - State:NC
Practice Address - Zip Code:27959-9045
Practice Address - Country:US
Practice Address - Phone:252-449-6115
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2020-12-04
Last Update Date:2022-05-31
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363A00000XPhysician Assistants & Advanced Practice Nursing ProvidersPhysician Assistant