Provider Demographics
NPI:1760569388
Name:SCHWADERER, CAROL RUTH (LPN)
Entity Type:Individual
Prefix:MISS
First Name:CAROL
Middle Name:RUTH
Last Name:SCHWADERER
Suffix:
Gender:F
Credentials:LPN
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:621 COLUMBUS SANDUSKY RD S
Mailing Address - Street 2:
Mailing Address - City:MARION
Mailing Address - State:OH
Mailing Address - Zip Code:43302-8910
Mailing Address - Country:US
Mailing Address - Phone:740-389-1098
Mailing Address - Fax:
Practice Address - Street 1:621 COLUMBUS SANDUSKY RD S
Practice Address - Street 2:
Practice Address - City:MARION
Practice Address - State:OH
Practice Address - Zip Code:43302-8910
Practice Address - Country:US
Practice Address - Phone:740-389-1098
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2006-11-01
Last Update Date:2007-07-09
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OHPN104790164W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes164W00000XNursing Service ProvidersLicensed Practical Nurse
Provider Identifiers
StateIdentifier IDID TypeIssuer
OH2683896Medicaid