Provider Demographics
NPI:1285628792
Name:SCHMIDTKE, ERIN MELISSA (MSN)
Entity Type:Individual
Prefix:MRS
First Name:ERIN
Middle Name:MELISSA
Last Name:SCHMIDTKE
Suffix:
Gender:F
Credentials:MSN
Other - Prefix:MS
Other - First Name:ERIN
Other - Middle Name:MELISSA
Other - Last Name:RUEHLE
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:MSN
Mailing Address - Street 1:5315 11TH AVE S
Mailing Address - Street 2:
Mailing Address - City:MINNEAPOLIS
Mailing Address - State:MN
Mailing Address - Zip Code:55417-1831
Mailing Address - Country:US
Mailing Address - Phone:612-824-1075
Mailing Address - Fax:
Practice Address - Street 1:324 E 35TH ST
Practice Address - Street 2:
Practice Address - City:MINNEAPOLIS
Practice Address - State:MN
Practice Address - Zip Code:55408-4580
Practice Address - Country:US
Practice Address - Phone:612-827-7181
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2005-09-12
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MNR1556537363LF0000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LF0000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerFamily
Provider Identifiers
StateIdentifier IDID TypeIssuer
Q40288Medicare UPIN