Provider Demographics
NPI:1982940359
Name:SCHMUTTE, NICOLE ELIZABETH (CRNA)
Entity Type:Individual
Prefix:
First Name:NICOLE
Middle Name:ELIZABETH
Last Name:SCHMUTTE
Suffix:
Gender:F
Credentials:CRNA
Other - Prefix:
Other - First Name:NICOLE
Other - Middle Name:E
Other - Last Name:HENKE
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:CRNA
Mailing Address - Street 1:340 THOMAS MORE PKWY
Mailing Address - Street 2:SUITE 220
Mailing Address - City:CRESTVIEW HILLS
Mailing Address - State:KY
Mailing Address - Zip Code:41017-5101
Mailing Address - Country:US
Mailing Address - Phone:859-341-2666
Mailing Address - Fax:859-341-7867
Practice Address - Street 1:375 DIXMYTH AVE
Practice Address - Street 2:
Practice Address - City:CINCINNATI
Practice Address - State:OH
Practice Address - Zip Code:45220-2475
Practice Address - Country:US
Practice Address - Phone:513-862-2432
Practice Address - Fax:859-341-7867
Is Sole Proprietor?:Yes
Enumeration Date:2012-12-12
Last Update Date:2016-12-29
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
KY1127187367500000X
OHRN323688367500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes367500000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse Anesthetist, Certified Registered
Provider Identifiers
StateIdentifier IDID TypeIssuer
KY7100230900Medicaid
KY50046799OtherPASSPORT HEALTH
KY50046799OtherPASSPORT HEALTH
KY7100230900Medicaid
KY7100230900Medicaid