Provider Demographics
NPI:1598957110
Name:SCHROEDER, DANIEL CHARLES (RN, PMHNP)
Entity Type:Individual
Prefix:MR
First Name:DANIEL
Middle Name:CHARLES
Last Name:SCHROEDER
Suffix:
Gender:M
Credentials:RN, PMHNP
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:PO BOX 82819
Mailing Address - Street 2:
Mailing Address - City:PORTLAND
Mailing Address - State:OR
Mailing Address - Zip Code:97282-0819
Mailing Address - Country:US
Mailing Address - Phone:503-233-5405
Mailing Address - Fax:
Practice Address - Street 1:21210 NW MAUZEY RD
Practice Address - Street 2:
Practice Address - City:HILLSBORO
Practice Address - State:OR
Practice Address - Zip Code:97124-9327
Practice Address - Country:US
Practice Address - Phone:503-439-9531
Practice Address - Fax:503-531-3841
Is Sole Proprietor?:No
Enumeration Date:2007-08-16
Last Update Date:2014-10-15
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OR200850118NP363LP0808X
WARN00168895163WP0809X
OR200642744RN163WP0809X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LP0808XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerPsychiatric/Mental Health
No163WP0809XNursing Service ProvidersRegistered NursePsychiatric/Mental Health, Adult
Provider Identifiers
StateIdentifier IDID TypeIssuer
OR164936Medicaid
OR0000WDBCHMedicare PIN