Provider Demographics
NPI:1508930074
Name:SCHMIDT, TONI R (RN)
Entity Type:Individual
Prefix:MRS
First Name:TONI
Middle Name:R
Last Name:SCHMIDT
Suffix:
Gender:F
Credentials:RN
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:745 TENNESSEE RD
Mailing Address - Street 2:
Mailing Address - City:WINLOCK
Mailing Address - State:WA
Mailing Address - Zip Code:98596-9744
Mailing Address - Country:US
Mailing Address - Phone:360-785-3528
Mailing Address - Fax:360-705-2012
Practice Address - Street 1:745 TENNESSEE RD
Practice Address - Street 2:
Practice Address - City:WINLOCK
Practice Address - State:WA
Practice Address - Zip Code:98596-9744
Practice Address - Country:US
Practice Address - Phone:360-785-3528
Practice Address - Fax:360-705-2012
Is Sole Proprietor?:Yes
Enumeration Date:2006-11-17
Last Update Date:2009-11-03
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WARN00116552163WR0006X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes163WR0006XNursing Service ProvidersRegistered NurseRegistered Nurse First Assistant
Provider Identifiers
StateIdentifier IDID TypeIssuer
WA9625419Medicaid