Provider Demographics
NPI:1265160014
Name:SCHMIDT, ELIZABETH (RN IBCLC)
Entity type:Individual
Prefix:
First Name:ELIZABETH
Middle Name:
Last Name:SCHMIDT
Suffix:
Gender:F
Credentials:RN IBCLC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:12200 ACADEMY RD NE APT 1326
Mailing Address - Street 2:
Mailing Address - City:ALBUQUERQUE
Mailing Address - State:NM
Mailing Address - Zip Code:87111-7257
Mailing Address - Country:US
Mailing Address - Phone:480-236-8059
Mailing Address - Fax:
Practice Address - Street 1:12 N CATHERINE AVE
Practice Address - Street 2:
Practice Address - City:LA GRANGE
Practice Address - State:IL
Practice Address - Zip Code:60525-5930
Practice Address - Country:US
Practice Address - Phone:312-761-1635
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2022-08-10
Last Update Date:2022-08-10
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NM59996163WL0100X
NMRN-89777163W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes163W00000XNursing Service ProvidersRegistered Nurse
No163WL0100XNursing Service ProvidersRegistered NurseLactation Consultant