Provider Demographics
NPI:1811587850
Name:NICOLE SCHUMANN PSYD, LP, LLC
Entity Type:Organization
Organization Name:NICOLE SCHUMANN PSYD, LP, LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:DR
Authorized Official - First Name:NICOLE
Authorized Official - Middle Name:M
Authorized Official - Last Name:SCHUMANN
Authorized Official - Suffix:
Authorized Official - Credentials:PSYD
Authorized Official - Phone:651-343-0850
Mailing Address - Street 1:12400 PORTLAND AVE STE 120
Mailing Address - Street 2:
Mailing Address - City:BURNSVILLE
Mailing Address - State:MN
Mailing Address - Zip Code:55337-6817
Mailing Address - Country:US
Mailing Address - Phone:952-236-6189
Mailing Address - Fax:952-213-6116
Practice Address - Street 1:12400 PORTLAND AVE STE 120
Practice Address - Street 2:
Practice Address - City:BURNSVILLE
Practice Address - State:MN
Practice Address - Zip Code:55337-6817
Practice Address - Country:US
Practice Address - Phone:952-236-6189
Practice Address - Fax:952-213-6116
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2021-01-23
Last Update Date:2021-01-23
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes261QM1300XAmbulatory Health Care FacilitiesClinic/CenterMulti-Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
1861725905OtherTYPE 1 NPI