Provider Demographics
NPI:1780626879
Name:SCHMIDT, NICOLE ANN (R-PAC)
Entity type:Individual
Prefix:MS
First Name:NICOLE
Middle Name:ANN
Last Name:SCHMIDT
Suffix:
Gender:F
Credentials:R-PAC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:18 LIMESTONE DRIVE
Mailing Address - Street 2:SUITE 5
Mailing Address - City:WILLIAMSVILLE
Mailing Address - State:NY
Mailing Address - Zip Code:14221
Mailing Address - Country:US
Mailing Address - Phone:716-632-1400
Mailing Address - Fax:716-632-5316
Practice Address - Street 1:18 LIMESTONE DRIVE
Practice Address - Street 2:SUITE 5
Practice Address - City:WILLIAMSVILLE
Practice Address - State:NY
Practice Address - Zip Code:14221
Practice Address - Country:US
Practice Address - Phone:716-632-1400
Practice Address - Fax:716-632-5316
Is Sole Proprietor?:No
Enumeration Date:2006-06-12
Last Update Date:2012-09-05
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY010347363AS0400X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363AS0400XPhysician Assistants & Advanced Practice Nursing ProvidersPhysician AssistantSurgical
Provider Identifiers
StateIdentifier IDID TypeIssuer
NY00840455Medicaid
NY00840455Medicaid
NYPA0868Medicare ID - Type Unspecified