Provider Demographics
NPI:1811129273
Name:SCHMIDT, MARY K (FNP)
Entity type:Individual
Prefix:
First Name:MARY
Middle Name:K
Last Name:SCHMIDT
Suffix:
Gender:F
Credentials:FNP
Other - Prefix:
Other - First Name:
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Other - Last Name:
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Other - Credentials:
Mailing Address - Street 1:360 SHERMAN ST.
Mailing Address - Street 2:SUITE 250
Mailing Address - City:ST PAUL
Mailing Address - State:MN
Mailing Address - Zip Code:55102
Mailing Address - Country:US
Mailing Address - Phone:651-772-6251
Mailing Address - Fax:651-224-9661
Practice Address - Street 1:360 SHERMAN ST.
Practice Address - Street 2:SUITE 250
Practice Address - City:ST PAUL
Practice Address - State:MN
Practice Address - Zip Code:55102
Practice Address - Country:US
Practice Address - Phone:651-772-6251
Practice Address - Fax:651-224-9661
Is Sole Proprietor?:No
Enumeration Date:2009-08-19
Last Update Date:2011-03-10
Deactivation Date:
Deactivation Code:
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Provider Licenses
StateLicense IDTaxonomies
MNR 085066-1363L00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363L00000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse Practitioner
Provider Identifiers
StateIdentifier IDID TypeIssuer
MN1811129273Medicaid
MN1811129273Medicaid