MEDICARE: JENNIFER SHMIDT FNP-BC

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	363LF0000X	Family Nurse Practitioner	95013001	CA

General Provider Information

NPI Number	:	1154965846
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	JENNIFER SHMIDT FNP-BC

Provider Business Mailing Address
First Line	:	6000 SAN VICENTE BLVD
Second Line	:
City	:	LOS ANGELES
State	:	CA
Zip	:	90036-4404
Country	:	US
Telephone Number	:	323-930-1040
Fax Number	:

Provider Business Practice Location Address
First Line	:	6000 SAN VICENTE BLVD
Second Line	:
City	:	LOS ANGELES
State	:	CA
Zip	:	90036-4404
Country	:	US
Telephone Number	:	323-930-1040
Fax Number	:

Authorized Official
Title or Position	:
Name	:
Credential	:
Telephone Number	:

Provider Enumeration Date	:	11/05/2019
Last Update Date	:	12/28/2019

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