Basic Information
| Provider Information | |||||||||
| NPI: | 1154674380 | ||||||||
| EntityType: | 1 | ||||||||
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| LastName: | SCHAIDLE | ||||||||
| FirstName: | COLLEEN | ||||||||
| MiddleName: | RENEE | ||||||||
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| Credential: | N.P. | ||||||||
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| Mailing Information | |||||||||
| Address1: | PSC 2 BOX 8509 | ||||||||
| Address2: | |||||||||
| City: | APO | ||||||||
| State: | AE | ||||||||
| PostalCode: | 090120035 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 4915158832446 | ||||||||
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| Practice Location | |||||||||
| Address1: | 2160 SOUTH FIRST AVE | ||||||||
| Address2: | LOYOLA UNIVERSITY MEDICAL CENTER | ||||||||
| City: | MAYWOOD | ||||||||
| State: | IL | ||||||||
| PostalCode: | 60153 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 8885847888 | ||||||||
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| Other Information | |||||||||
| ProviderEnumerationDate: | 10/25/2012 | ||||||||
| LastUpdateDate: | 10/25/2012 | ||||||||
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| ProviderGenderCode: | F | ||||||||
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| IsSoleProprietor: | N | ||||||||
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Taxonomy Information
| Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 363LA2200X | 209.009841 | IL | Y | Physician Assistants & Advanced Practice Nursing Providers | Nurse Practitioner | Adult Health |
No ID Information.