Provider Demographics
NPI:1356300909
Name:SCHMIEDER, ANGELA (PA-C)
Entity Type:Individual
Prefix:MS
First Name:ANGELA
Middle Name:
Last Name:SCHMIEDER
Suffix:
Gender:F
Credentials:PA-C
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:525 VALLEY VIEW DR
Mailing Address - Street 2:
Mailing Address - City:MOLINE
Mailing Address - State:IL
Mailing Address - Zip Code:61265-6138
Mailing Address - Country:US
Mailing Address - Phone:309-762-9869
Mailing Address - Fax:309-762-2313
Practice Address - Street 1:525 VALLEY VIEW DR
Practice Address - Street 2:
Practice Address - City:MOLINE
Practice Address - State:IL
Practice Address - Zip Code:61265-6138
Practice Address - Country:US
Practice Address - Phone:309-762-9869
Practice Address - Fax:309-762-2313
Is Sole Proprietor?:No
Enumeration Date:2006-03-22
Last Update Date:2012-05-21
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IL085002345363A00000X
IA001659363A00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363A00000XPhysician Assistants & Advanced Practice Nursing ProvidersPhysician Assistant
Provider Identifiers
StateIdentifier IDID TypeIssuer
IL0181OtherJOHN DEERE ILLINOIS
90274OtherBCWELLMARK
IA0101OtherJOHN DEERE IOWA
IA1356300909Medicaid
90282OtherBCWELLMARK
IL0181OtherJOHN DEERE ILLINOIS
K13477Medicare ID - Type UnspecifiedMEDICARE IND ILLINOIS
90282OtherBCWELLMARK
IL200715001Medicare PIN