Provider Demographics
NPI:1013053305
Name:SCHRADER, SHARI ANNE (APRNBC)
Entity Type:Individual
Prefix:
First Name:SHARI
Middle Name:ANNE
Last Name:SCHRADER
Suffix:
Gender:F
Credentials:APRNBC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:300 RANDALL RD
Mailing Address - Street 2:WOUND CENTER
Mailing Address - City:GENEVA
Mailing Address - State:IL
Mailing Address - Zip Code:60134-4200
Mailing Address - Country:US
Mailing Address - Phone:630-208-4460
Mailing Address - Fax:630-208-4338
Practice Address - Street 1:300 RANDALL RD
Practice Address - Street 2:WOUND CENTER
Practice Address - City:GENEVA
Practice Address - State:IL
Practice Address - Zip Code:60134-4200
Practice Address - Country:US
Practice Address - Phone:630-208-4460
Practice Address - Fax:630-208-4338
Is Sole Proprietor?:Yes
Enumeration Date:2007-01-30
Last Update Date:2023-03-07
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IL209-005251363LA2200X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LA2200XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerAdult Health
Provider Identifiers
StateIdentifier IDID TypeIssuer
ID209-005251OtherADVANCED PRACTICE LICENSE
ID0387812-21OtherANCC CERTIFICATION
ILMS1465980OtherDEA
ILK23757Medicare UPIN