Provider Demographics
NPI:1497227813
Name:SCHROEDER, NICOLE KRISTEN
Entity Type:Individual
Prefix:MRS
First Name:NICOLE
Middle Name:KRISTEN
Last Name:SCHROEDER
Suffix:
Gender:F
Credentials:
Other - Prefix:MS
Other - First Name:NICOLE
Other - Middle Name:KRISTEN
Other - Last Name:SCHROEDER
Other - Suffix:
Other - Last Name Type:Professional Name
Other - Credentials:
Mailing Address - Street 1:11230 RED BIRD LN
Mailing Address - Street 2:
Mailing Address - City:HAMMOND
Mailing Address - State:LA
Mailing Address - Zip Code:70401-4602
Mailing Address - Country:US
Mailing Address - Phone:985-687-7195
Mailing Address - Fax:
Practice Address - Street 1:823 CARROLL ST STE B
Practice Address - Street 2:
Practice Address - City:MANDEVILLE
Practice Address - State:LA
Practice Address - Zip Code:70448-5126
Practice Address - Country:US
Practice Address - Phone:985-674-0488
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2018-12-24
Last Update Date:2018-12-24
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes171M00000XOther Service ProvidersCase Manager/Care Coordinator