Provider Demographics
NPI:1134106545
Name:SCHROEDER, DARA MARIE (PA-C)
Entity Type:Individual
Prefix:
First Name:DARA
Middle Name:MARIE
Last Name:SCHROEDER
Suffix:
Gender:F
Credentials:PA-C
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1352 GARRETT AVE
Mailing Address - Street 2:
Mailing Address - City:WAHOO
Mailing Address - State:NE
Mailing Address - Zip Code:68066-4096
Mailing Address - Country:US
Mailing Address - Phone:402-443-1518
Mailing Address - Fax:
Practice Address - Street 1:600 N COTNER BLVD
Practice Address - Street 2:SUITE 208
Practice Address - City:LINCOLN
Practice Address - State:NE
Practice Address - Zip Code:68505-2343
Practice Address - Country:US
Practice Address - Phone:402-464-5969
Practice Address - Fax:402-464-3657
Is Sole Proprietor?:No
Enumeration Date:2005-12-28
Last Update Date:2016-07-13
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NE1103363AM0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363AM0700XPhysician Assistants & Advanced Practice Nursing ProvidersPhysician AssistantMedical
Provider Identifiers
StateIdentifier IDID TypeIssuer
NE1103OtherSTATE LICENSE NUMBER
NE1103OtherSTATE LICENSE NUMBER