Provider Demographics
NPI:1174343222
Name:SCHMIDT, KARISSA
Entity type:Individual
Prefix:
First Name:KARISSA
Middle Name:
Last Name:SCHMIDT
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:KARISSA
Other - Middle Name:
Other - Last Name:HANTZ
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:
Mailing Address - Street 1:216 SPRUCE ST
Mailing Address - Street 2:
Mailing Address - City:WALNUTPORT
Mailing Address - State:PA
Mailing Address - Zip Code:18088-1639
Mailing Address - Country:US
Mailing Address - Phone:610-216-3633
Mailing Address - Fax:
Practice Address - Street 1:216 SPRUCE ST
Practice Address - Street 2:
Practice Address - City:WALNUTPORT
Practice Address - State:PA
Practice Address - Zip Code:18088-1639
Practice Address - Country:US
Practice Address - Phone:610-216-3633
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2024-10-14
Last Update Date:2024-10-14
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes390200000XStudent, Health CareStudent in an Organized Health Care Education/Training Program