Provider Demographics
NPI:1427754209
Name:SCHRODER, CHASSIDY MAE (FNP)
Entity type:Individual
Prefix:
First Name:CHASSIDY
Middle Name:MAE
Last Name:SCHRODER
Suffix:
Gender:M
Credentials:FNP
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:501 KNOX ST
Mailing Address - Street 2:
Mailing Address - City:LA GRANGE
Mailing Address - State:MO
Mailing Address - Zip Code:63448-1359
Mailing Address - Country:US
Mailing Address - Phone:217-430-5061
Mailing Address - Fax:
Practice Address - Street 1:326 N 24TH ST
Practice Address - Street 2:
Practice Address - City:QUINCY
Practice Address - State:IL
Practice Address - Zip Code:62301-3140
Practice Address - Country:US
Practice Address - Phone:217-214-6300
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2023-02-03
Last Update Date:2024-04-23
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IL209.026735363LP2300X
IL209026735363LF0000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LF0000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerFamily
No363LP2300XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerPrimary Care