Provider Demographics
NPI:1407273634
Name:SCHRODER, MARY (RN, IBCLC)
Entity Type:Individual
Prefix:
First Name:MARY
Middle Name:
Last Name:SCHRODER
Suffix:
Gender:F
Credentials:RN, IBCLC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:7711 OLD HIGHWAY 111
Mailing Address - Street 2:
Mailing Address - City:MEMPHIS
Mailing Address - State:IN
Mailing Address - Zip Code:47143-9661
Mailing Address - Country:US
Mailing Address - Phone:502-643-8195
Mailing Address - Fax:812-246-5731
Practice Address - Street 1:7711 OLD HIGHWAY 111
Practice Address - Street 2:
Practice Address - City:MEMPHIS
Practice Address - State:IN
Practice Address - Zip Code:47143-9661
Practice Address - Country:US
Practice Address - Phone:502-643-8195
Practice Address - Fax:812-246-5731
Is Sole Proprietor?:Yes
Enumeration Date:2014-03-26
Last Update Date:2014-03-26
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
KY1060243163WL0100X
IN28097083A163WL0100X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes163WL0100XNursing Service ProvidersRegistered NurseLactation Consultant