Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 363LP0200X | Nurse Practitioner - Pediatrics | C123209 | IA |
NPI | 1033551916 |
---|---|
Provider Name | Emily Schadt |
First Address | Moline, IL 61265-6867 |
Second Address | Moline, IL 61265-6867 |
Gender | F |
NPI Entity type | Individual |
Is Sole Proprietor | Yes |
Is Organization Subpart | N/A |
Enumeration Date | 22/07/2013 |
Last Update Date | 12/07/2016 |