Provider Demographics
NPI:1932234614
Name:SCHMID, KATHERINE ANNE (RD)
Entity Type:Individual
Prefix:
First Name:KATHERINE
Middle Name:ANNE
Last Name:SCHMID
Suffix:
Gender:F
Credentials:RD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:11193 GLEN AVON WAY
Mailing Address - Street 2:
Mailing Address - City:ZIONSVILLE
Mailing Address - State:IN
Mailing Address - Zip Code:46077-1287
Mailing Address - Country:US
Mailing Address - Phone:847-867-6942
Mailing Address - Fax:317-344-0265
Practice Address - Street 1:11193 GLEN AVON WAY
Practice Address - Street 2:
Practice Address - City:ZIONSVILLE
Practice Address - State:IN
Practice Address - Zip Code:46077-1287
Practice Address - Country:US
Practice Address - Phone:847-867-6942
Practice Address - Fax:317-344-0265
Is Sole Proprietor?:Yes
Enumeration Date:2007-02-22
Last Update Date:2012-12-29
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IL164002523133V00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes133V00000XDietary & Nutritional Service ProvidersDietitian, Registered
Provider Identifiers
StateIdentifier IDID TypeIssuer
IL01632756OtherBLUE SHIELD PROVIDER NUMB