Provider Demographics
NPI:1528588175
Name:SHRADAR, EDWARD N (RN)
Entity Type:Individual
Prefix:
First Name:EDWARD
Middle Name:N
Last Name:SHRADAR
Suffix:
Gender:M
Credentials:RN
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:4390 CONEJO DR
Mailing Address - Street 2:
Mailing Address - City:DANVILLE
Mailing Address - State:CA
Mailing Address - Zip Code:94506-6258
Mailing Address - Country:US
Mailing Address - Phone:925-785-6227
Mailing Address - Fax:
Practice Address - Street 1:4390 CONEJO DR
Practice Address - Street 2:
Practice Address - City:DANVILLE
Practice Address - State:CA
Practice Address - Zip Code:94506-6258
Practice Address - Country:US
Practice Address - Phone:925-785-6227
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2017-06-25
Last Update Date:2022-07-21
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA387066163W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes163W00000XNursing Service ProvidersRegistered Nurse