Provider Demographics
NPI:1396739801
Name:SCHWADER, ANNETTA S (ANP)
Entity type:Individual
Prefix:
First Name:ANNETTA
Middle Name:S
Last Name:SCHWADER
Suffix:
Gender:F
Credentials:ANP
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1226 LINN ST
Mailing Address - Street 2:SUITE F
Mailing Address - City:SIKESTON
Mailing Address - State:MO
Mailing Address - Zip Code:63801-5200
Mailing Address - Country:US
Mailing Address - Phone:573-481-0700
Mailing Address - Fax:573-481-0787
Practice Address - Street 1:1226 LINN ST
Practice Address - Street 2:SUITE F
Practice Address - City:SIKESTON
Practice Address - State:MO
Practice Address - Zip Code:63801-5200
Practice Address - Country:US
Practice Address - Phone:573-481-0700
Practice Address - Fax:573-481-0787
Is Sole Proprietor?:No
Enumeration Date:2005-09-12
Last Update Date:2013-01-26
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MO135427363LA2200X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LA2200XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerAdult Health
Provider Identifiers
StateIdentifier IDID TypeIssuer
MO1396739801Medicaid
MO1396739801Medicaid
MO000082617Medicare ID - Type Unspecified