Provider Demographics
NPI:1124183249
Name:SCHMIDT, JUDITH A (CRNA)
Entity Type:Individual
Prefix:
First Name:JUDITH
Middle Name:A
Last Name:SCHMIDT
Suffix:
Gender:F
Credentials:CRNA
Other - Prefix:
Other - First Name:JUDITH
Other - Middle Name:A
Other - Last Name:BERNDT
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:
Mailing Address - Street 1:1000 MINERAL POINT AVE
Mailing Address - Street 2:
Mailing Address - City:JANESVILLE
Mailing Address - State:WI
Mailing Address - Zip Code:53548-2940
Mailing Address - Country:US
Mailing Address - Phone:608-756-6731
Mailing Address - Fax:608-756-6013
Practice Address - Street 1:1000 MINERAL POINT AVE
Practice Address - Street 2:
Practice Address - City:JANESVILLE
Practice Address - State:WI
Practice Address - Zip Code:53548-2940
Practice Address - Country:US
Practice Address - Phone:608-756-6731
Practice Address - Fax:608-756-6013
Is Sole Proprietor?:No
Enumeration Date:2006-12-27
Last Update Date:2018-03-29
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WI117974-30163W00000X
IL041.212422163W00000X
IL209-007415367500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes367500000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse Anesthetist, Certified Registered
No163W00000XNursing Service ProvidersRegistered Nurse
Provider Identifiers
StateIdentifier IDID TypeIssuer
WI1124183249Medicaid
IL$$$$$$$$$Medicaid
WI43346400Medicaid
593490003Medicare PIN
WI003221363Medicare PIN
ILP01553449Medicare PIN