Provider Demographics
NPI:1659802049
Name:SCHMIDT, JUDITH MICHELLE (RN)
Entity Type:Individual
Prefix:
First Name:JUDITH
Middle Name:MICHELLE
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 1:887 NE TERRITORIAL RD
Mailing Address - Street 2:
Mailing Address - City:CANBY
Mailing Address - State:OR
Mailing Address - Zip Code:97013-9136
Mailing Address - Country:US
Mailing Address - Phone:928-580-8686
Mailing Address - Fax:503-416-4553
Practice Address - Street 1:178 SW 2ND AVE
Practice Address - Street 2:
Practice Address - City:CANBY
Practice Address - State:OR
Practice Address - Zip Code:97013-4152
Practice Address - Country:US
Practice Address - Phone:503-416-4547
Practice Address - Fax:503-416-4553
Is Sole Proprietor?:Yes
Enumeration Date:2017-03-27
Last Update Date:2017-03-27
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OR201508359RN163W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes163W00000XNursing Service ProvidersRegistered Nurse