Provider Demographics
NPI:1083266852
Name:SCHMIDT, MIKALA (NP)
Entity Type:Individual
Prefix:
First Name:MIKALA
Middle Name:
Last Name:SCHMIDT
Suffix:
Gender:F
Credentials:NP
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:9828 HIDDEN VILLAGE PL
Mailing Address - Street 2:
Mailing Address - City:FORT WAYNE
Mailing Address - State:IN
Mailing Address - Zip Code:46835-9385
Mailing Address - Country:US
Mailing Address - Phone:260-557-4349
Mailing Address - Fax:
Practice Address - Street 1:2810 DUPONT COMMERCE CT
Practice Address - Street 2:
Practice Address - City:FORT WAYNE
Practice Address - State:IN
Practice Address - Zip Code:46825-2393
Practice Address - Country:US
Practice Address - Phone:260-490-7337
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2019-07-11
Last Update Date:2019-07-11
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IN28236383A363LP0200X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LP0200XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerPediatrics