Provider Demographics
NPI:1902356280
Name:SCHROEDER, BONNIE CORALIE (PA- C)
Entity Type:Individual
Prefix:
First Name:BONNIE
Middle Name:CORALIE
Last Name:SCHROEDER
Suffix:
Gender:F
Credentials:PA- C
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:234 N CENTRAL AVE STE 5000
Mailing Address - Street 2:
Mailing Address - City:PHOENIX
Mailing Address - State:AZ
Mailing Address - Zip Code:85004-2228
Mailing Address - Country:US
Mailing Address - Phone:602-506-2906
Mailing Address - Fax:
Practice Address - Street 1:201 S 4TH AVE
Practice Address - Street 2:
Practice Address - City:PHOENIX
Practice Address - State:AZ
Practice Address - Zip Code:85003-2138
Practice Address - Country:US
Practice Address - Phone:602-876-4636
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2016-10-10
Last Update Date:2021-05-06
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
AZ6482363AM0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363AM0700XPhysician Assistants & Advanced Practice Nursing ProvidersPhysician AssistantMedical