Provider Demographics
NPI:1467600627
Name:SCHMIDT, ELIZABETH HANSON (PA-C)
Entity Type:Individual
Prefix:MRS
First Name:ELIZABETH
Middle Name:HANSON
Last Name:SCHMIDT
Suffix:
Gender:F
Credentials:PA-C
Other - Prefix:MISS
Other - First Name:ELIZABETH
Other - Middle Name:ANNE
Other - Last Name:HANSON
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:PA-C
Mailing Address - Street 1:12360 CREEKWOOD LN
Mailing Address - Street 2:
Mailing Address - City:CARMEL
Mailing Address - State:IN
Mailing Address - Zip Code:46032-8287
Mailing Address - Country:US
Mailing Address - Phone:317-844-0852
Mailing Address - Fax:317-844-0852
Practice Address - Street 1:12360 CREEKWOOD LN
Practice Address - Street 2:
Practice Address - City:CARMEL
Practice Address - State:IN
Practice Address - Zip Code:46032-8287
Practice Address - Country:US
Practice Address - Phone:317-844-0852
Practice Address - Fax:317-844-0852
Is Sole Proprietor?:No
Enumeration Date:2008-08-29
Last Update Date:2008-08-29
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IN10000415A363A00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363A00000XPhysician Assistants & Advanced Practice Nursing ProvidersPhysician Assistant
Provider Identifiers
StateIdentifier IDID TypeIssuer
IN231060AMedicare PIN