Provider Demographics
NPI:1447830591
Name:SCHROEDER, GWEN CATHY (REGISTERED NURSE)
Entity type:Individual
Prefix:
First Name:GWEN
Middle Name:CATHY
Last Name:SCHROEDER
Suffix:
Gender:F
Credentials:REGISTERED NURSE
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:49415 ALI CT
Mailing Address - Street 2:
Mailing Address - City:LA QUINTA
Mailing Address - State:CA
Mailing Address - Zip Code:92253-8144
Mailing Address - Country:US
Mailing Address - Phone:760-485-9197
Mailing Address - Fax:
Practice Address - Street 1:49415 ALI CT
Practice Address - Street 2:
Practice Address - City:LA QUINTA
Practice Address - State:CA
Practice Address - Zip Code:92253-8144
Practice Address - Country:US
Practice Address - Phone:760-485-9197
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2021-04-13
Last Update Date:2021-04-13
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA429780163W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes163W00000XNursing Service ProvidersRegistered Nurse