Provider Demographics
NPI:1265523906
Name:SCHROEDER, DEANNA J (FNP-BC)
Entity type:Individual
Prefix:MRS
First Name:DEANNA
Middle Name:J
Last Name:SCHROEDER
Suffix:
Gender:F
Credentials:FNP-BC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:375 N WALL ST STE P310
Mailing Address - Street 2:
Mailing Address - City:KANKAKEE
Mailing Address - State:IL
Mailing Address - Zip Code:60901-3484
Mailing Address - Country:US
Mailing Address - Phone:815-933-0194
Mailing Address - Fax:815-936-3847
Practice Address - Street 1:375 N WALL ST STE P310
Practice Address - Street 2:
Practice Address - City:KANKAKEE
Practice Address - State:IL
Practice Address - Zip Code:60901-3484
Practice Address - Country:US
Practice Address - Phone:815-933-0194
Practice Address - Fax:815-936-3847
Is Sole Proprietor?:No
Enumeration Date:2006-09-27
Last Update Date:2021-03-29
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IL209.001021363LF0000X
IL209-001021363LF0000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LF0000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerFamily
Provider Identifiers
StateIdentifier IDID TypeIssuer
ILP54265Medicare UPIN
IL36-3167726Medicare PIN
P54265Medicare UPIN