Basic Information
| Provider Information | |||||||||
| NPI: | 1699924407 | ||||||||
| EntityType: | 1 | ||||||||
| ReplacementNPI: | |||||||||
| OrganizationName: | |||||||||
| LastName: | SCHRADER | ||||||||
| FirstName: | CRYSTAL | ||||||||
| MiddleName: | DAWN | ||||||||
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| Credential: | ARNP | ||||||||
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| Mailing Information | |||||||||
| Address1: | 4150 KIMBALL AVE | ||||||||
| Address2: | PO BOX 2758 | ||||||||
| City: | WATERLOO | ||||||||
| State: | IA | ||||||||
| PostalCode: | 507019086 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 3192355390 | ||||||||
| FaxNumber: | 3192331630 | ||||||||
| Practice Location | |||||||||
| Address1: | 110 PLAZA CIR STE A | ||||||||
| Address2: | |||||||||
| City: | WATERLOO | ||||||||
| State: | IA | ||||||||
| PostalCode: | 507015139 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 3192367720 | ||||||||
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| Other Information | |||||||||
| ProviderEnumerationDate: | 09/17/2008 | ||||||||
| LastUpdateDate: | 02/07/2022 | ||||||||
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| ProviderGenderCode: | F | ||||||||
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| IsSoleProprietor: | N | ||||||||
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| NPICertificationDate: | 02/07/2022 | ||||||||
Taxonomy Information
| Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 363L00000X | A110710 | IA | Y | Physician Assistants & Advanced Practice Nursing Providers | Nurse Practitioner |
No ID Information.