Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
N | 363L00000X | Nurse Practitioner | 4704278975 | MI |
Y | 363LP2300X | Nurse Practitioner - Primary Care | 4704278975 | MI |
NPI | 1003285859 |
---|---|
Provider Name | Justine Schrader |
First Address | Lakeport, MI 48059-1903 |
Second Address | Port Huron, MI 48060-8639 |
Gender | F |
NPI Entity type | Individual |
Is Sole Proprietor | Yes |
Is Organization Subpart | N/A |
Enumeration Date | 23/09/2015 |
Last Update Date | 17/03/2018 |