Provider Demographics
NPI:1245952290
Name:SCHROEDER, DIANDRA LEE (RN)
Entity type:Individual
Prefix:MRS
First Name:DIANDRA
Middle Name:LEE
Last Name:SCHROEDER
Suffix:
Gender:F
Credentials:RN
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:240 CHATSWORTH AVE
Mailing Address - Street 2:
Mailing Address - City:SUGAR GROVE
Mailing Address - State:IL
Mailing Address - Zip Code:60554-9475
Mailing Address - Country:US
Mailing Address - Phone:630-788-1511
Mailing Address - Fax:
Practice Address - Street 1:17 FOX GLEN CIR
Practice Address - Street 2:
Practice Address - City:YORKVILLE
Practice Address - State:IL
Practice Address - Zip Code:60560-9589
Practice Address - Country:US
Practice Address - Phone:630-788-1511
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2022-09-15
Last Update Date:2022-09-15
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IL041.325442163W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes163W00000XNursing Service ProvidersRegistered Nurse