Provider Demographics
NPI:1881836245
Name:SCHROEDER, JUSTIN T (CRNA)
Entity Type:Individual
Prefix:
First Name:JUSTIN
Middle Name:T
Last Name:SCHROEDER
Suffix:
Gender:M
Credentials:CRNA
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:80 1ST ST
Mailing Address - Street 2:
Mailing Address - City:PRAIRIE DU SAC
Mailing Address - State:WI
Mailing Address - Zip Code:53578-1550
Mailing Address - Country:US
Mailing Address - Phone:608-643-3311
Mailing Address - Fax:608-643-8600
Practice Address - Street 1:80 1ST ST
Practice Address - Street 2:
Practice Address - City:PRAIRIE DU SAC
Practice Address - State:WI
Practice Address - Zip Code:53578-1550
Practice Address - Country:US
Practice Address - Phone:608-643-3311
Practice Address - Fax:608-643-8600
Is Sole Proprietor?:No
Enumeration Date:2009-04-01
Last Update Date:2013-08-20
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WI130857367500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes367500000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse Anesthetist, Certified Registered