Provider Demographics
NPI:1073878963
Name:SCHRODER, MARY CONNELL (RN)
Entity Type:Individual
Prefix:
First Name:MARY
Middle Name:CONNELL
Last Name:SCHRODER
Suffix:
Gender:F
Credentials:RN
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:13010 SW IRON MOUNTAIN BLVD
Mailing Address - Street 2:
Mailing Address - City:PORTLAND
Mailing Address - State:OR
Mailing Address - Zip Code:97219-8520
Mailing Address - Country:US
Mailing Address - Phone:503-699-7339
Mailing Address - Fax:
Practice Address - Street 1:13010 SW IRON MOUNTAIN BLVD
Practice Address - Street 2:
Practice Address - City:PORTLAND
Practice Address - State:OR
Practice Address - Zip Code:97219-8520
Practice Address - Country:US
Practice Address - Phone:503-699-7339
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2012-07-07
Last Update Date:2012-07-07
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OR201140001RN163W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes163W00000XNursing Service ProvidersRegistered Nurse