Healthcare Provider Details

I. General information

NPI: 1306813878
Provider Name (Legal Business Name): BETTY RIEHL SCHMIDT CRNA
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 03/03/2006
Last Update Date: 10/08/2008
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

4440 W 95TH ST
OAK LAWN IL
60453-2600
US

IV. Provider business mailing address

175 N HARBOR DR #2804
CHICAGO IL
60601-7344
US

V. Phone/Fax

Practice location:
  • Phone: 708-684-5745
  • Fax:
Mailing address:
  • Phone: 315-373-3974
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code367500000X
TaxonomyCertified Registered Nurse Anesthetist
License Number463650
License Number StateNY
# 2
Primary TaxonomyN
Taxonomy Code367500000X
TaxonomyCertified Registered Nurse Anesthetist
License Number209.006470
License Number StateIL

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: