Basic Information
| Provider Information | |||||||||
| NPI: | 1053752220 | ||||||||
| EntityType: | 1 | ||||||||
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| OrganizationName: | |||||||||
| LastName: | SCHROEDER | ||||||||
| FirstName: | TARA | ||||||||
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| Credential: | NP | ||||||||
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| Mailing Information | |||||||||
| Address1: | 2110 TURPIN ST | ||||||||
| Address2: | |||||||||
| City: | SAINT PETER | ||||||||
| State: | MN | ||||||||
| PostalCode: | 560821776 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 6056603288 | ||||||||
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| Practice Location | |||||||||
| Address1: | 101 MARTIN LUTHER KING DR | ||||||||
| Address2: | |||||||||
| City: | MANKATO | ||||||||
| State: | MN | ||||||||
| PostalCode: | 560016460 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 5073856500 | ||||||||
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| Other Information | |||||||||
| ProviderEnumerationDate: | 07/16/2013 | ||||||||
| LastUpdateDate: | 09/18/2020 | ||||||||
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| ProviderGenderCode: | F | ||||||||
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| IsSoleProprietor: | N | ||||||||
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| NPICertificationDate: | 09/18/2020 | ||||||||
Taxonomy Information
| Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 363LF0000X | F0613893 | MN | Y | Physician Assistants & Advanced Practice Nursing Providers | Nurse Practitioner | Family |
No ID Information.