Provider Demographics
NPI:1497238273
Name:SCHMITZ, DIANE MONICA (PA-C)
Entity Type:Individual
Prefix:
First Name:DIANE
Middle Name:MONICA
Last Name:SCHMITZ
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 1:2055 MYRTLE AVE NE
Mailing Address - Street 2:
Mailing Address - City:SALEM
Mailing Address - State:OR
Mailing Address - Zip Code:97301-7269
Mailing Address - Country:US
Mailing Address - Phone:509-979-6761
Mailing Address - Fax:
Practice Address - Street 1:960 LIBERTY ST SE STE 200
Practice Address - Street 2:
Practice Address - City:SALEM
Practice Address - State:OR
Practice Address - Zip Code:97302-4195
Practice Address - Country:US
Practice Address - Phone:503-399-0652
Practice Address - Fax:503-373-3852
Is Sole Proprietor?:No
Enumeration Date:2018-09-08
Last Update Date:2019-12-06
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
ORPA195972363A00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363A00000XPhysician Assistants & Advanced Practice Nursing ProvidersPhysician Assistant