Provider Demographics
NPI:1710420609
Name:SCHMALTZ, EMILY MARIE
Entity Type:Individual
Prefix:
First Name:EMILY
Middle Name:MARIE
Last Name:SCHMALTZ
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:124 W INDIAN TRL
Mailing Address - Street 2:
Mailing Address - City:MILAN
Mailing Address - State:IN
Mailing Address - Zip Code:47031-8992
Mailing Address - Country:US
Mailing Address - Phone:812-654-7037
Mailing Address - Fax:812-654-7158
Practice Address - Street 1:124 W INDIAN TRL
Practice Address - Street 2:
Practice Address - City:MILAN
Practice Address - State:IN
Practice Address - Zip Code:47031-8992
Practice Address - Country:US
Practice Address - Phone:812-496-8784
Practice Address - Fax:812-654-7158
Is Sole Proprietor?:No
Enumeration Date:2016-11-23
Last Update Date:2022-08-09
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
KY3014923363L00000X
IN71006972A363L00000X
IN28202245A163WE0003X, 363L00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363L00000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse Practitioner
No163WE0003XNursing Service ProvidersRegistered NurseEmergency
Provider Identifiers
StateIdentifier IDID TypeIssuer
IN300003471Medicaid
OH0213789Medicaid
KY7100655870Medicaid