Provider Demographics
NPI:1003219932
Name:SCHMIDGALL, LINDA
Entity Type:Individual
Prefix:
First Name:LINDA
Middle Name:
Last Name:SCHMIDGALL
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:420 NE GLEN OAK AVE
Mailing Address - Street 2:SUITE 201
Mailing Address - City:PEORIA
Mailing Address - State:IL
Mailing Address - Zip Code:61603-3105
Mailing Address - Country:US
Mailing Address - Phone:309-624-5100
Mailing Address - Fax:309-624-5569
Practice Address - Street 1:420 NE GLEN OAK AVE
Practice Address - Street 2:SUITE 200
Practice Address - City:PEORIA
Practice Address - State:IL
Practice Address - Zip Code:61603-3105
Practice Address - Country:US
Practice Address - Phone:309-624-5100
Practice Address - Fax:309-624-5569
Is Sole Proprietor?:No
Enumeration Date:2014-10-07
Last Update Date:2014-10-13
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IL209-009627363L00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363L00000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse Practitioner