Provider Demographics
NPI:1477071892
Name:SCHMIDT, CONSTANCE KAY (CNS)
Entity Type:Individual
Prefix:MRS
First Name:CONSTANCE
Middle Name:KAY
Last Name:SCHMIDT
Suffix:
Gender:F
Credentials:CNS
Other - Prefix:
Other - First Name:CONNIE
Other - Middle Name:
Other - Last Name:KOOIMAN
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:CNS
Mailing Address - Street 1:30371 473RD AVE
Mailing Address - Street 2:
Mailing Address - City:BERESFORD
Mailing Address - State:SD
Mailing Address - Zip Code:57004-6934
Mailing Address - Country:US
Mailing Address - Phone:605-328-5246
Mailing Address - Fax:
Practice Address - Street 1:1305 W 18TH ST
Practice Address - Street 2:
Practice Address - City:SIOUX FALLS
Practice Address - State:SD
Practice Address - Zip Code:57105
Practice Address - Country:US
Practice Address - Phone:605-328-5246
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2017-09-06
Last Update Date:2018-06-21
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
SDCS004100364S00000X
SDCP000311363LF0000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LF0000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerFamily
No364S00000XPhysician Assistants & Advanced Practice Nursing ProvidersClinical Nurse Specialist