Provider Demographics
NPI:1801361894
Name:SCHRADER, VENESSA
Entity Type:Individual
Prefix:
First Name:VENESSA
Middle Name:
Last Name:SCHRADER
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:211 MASSILLON ST
Mailing Address - Street 2:
Mailing Address - City:WILMOT
Mailing Address - State:OH
Mailing Address - Zip Code:44689-9618
Mailing Address - Country:US
Mailing Address - Phone:330-605-3369
Mailing Address - Fax:
Practice Address - Street 1:211 MASSILLON ST
Practice Address - Street 2:
Practice Address - City:WILMOT
Practice Address - State:OH
Practice Address - Zip Code:44689-9618
Practice Address - Country:US
Practice Address - Phone:330-605-3369
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2018-10-05
Last Update Date:2018-10-05
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OH148211164W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes164W00000XNursing Service ProvidersLicensed Practical Nurse