Provider Demographics
NPI:1942343645
Name:SCHMIDT, TIMOTHY D (CRNA)
Entity Type:Individual
Prefix:
First Name:TIMOTHY
Middle Name:D
Last Name:SCHMIDT
Suffix:
Gender:M
Credentials:CRNA
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:W6840 RYDBERG RD
Mailing Address - Street 2:
Mailing Address - City:SPOONER
Mailing Address - State:WI
Mailing Address - Zip Code:54801-7677
Mailing Address - Country:US
Mailing Address - Phone:715-635-2313
Mailing Address - Fax:
Practice Address - Street 1:819 ASH ST
Practice Address - Street 2:SPOONER HEALTH SYSTEM
Practice Address - City:SPOONER
Practice Address - State:WI
Practice Address - Zip Code:54801-1201
Practice Address - Country:US
Practice Address - Phone:715-635-2111
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2007-02-14
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WI80860-030367500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes367500000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse Anesthetist, Certified Registered