Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 363LP0808X | Nurse Practitioner - Psychiatric/Mental Health | 400328 | NY |
NPI | 1023190709 |
---|---|
Provider Name | Mrs. Thea D Schneider |
First Address | Edgewood, NM 87015-7935 |
Second Address | Albuquerque, NM 87108-5153 |
Gender | F |
NPI Entity type | Individual |
Is Sole Proprietor | No |
Is Organization Subpart | N/A |
Enumeration Date | 20/10/2006 |
Last Update Date | 12/09/2007 |