Provider Demographics
NPI:1770135303
Name:SHRADER, AMELIA ELENA (CRNA)
Entity type:Individual
Prefix:
First Name:AMELIA
Middle Name:ELENA
Last Name:SHRADER
Suffix:
Gender:F
Credentials:CRNA
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:638 MEMORIAL DR
Mailing Address - Street 2:
Mailing Address - City:RISING FAWN
Mailing Address - State:GA
Mailing Address - Zip Code:30738-5126
Mailing Address - Country:US
Mailing Address - Phone:423-315-3514
Mailing Address - Fax:
Practice Address - Street 1:200 MEDICAL CENTER DR SW
Practice Address - Street 2:
Practice Address - City:FORT PAYNE
Practice Address - State:AL
Practice Address - Zip Code:35968-3458
Practice Address - Country:US
Practice Address - Phone:256-845-3150
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2019-07-13
Last Update Date:2025-05-18
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TX1004305367500000X, 367500000X
AL3-000998367500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes367500000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse Anesthetist, Certified Registered