Healthcare Provider Details

I. General information

NPI: 1083266852
Provider Name (Legal Business Name): MIKALA SCHMIDT NP
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 07/11/2019
Last Update Date: 07/11/2019
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

2810 DUPONT COMMERCE CT
FORT WAYNE IN
46825-2393
US

IV. Provider business mailing address

9828 HIDDEN VILLAGE PL
FORT WAYNE IN
46835-9385
US

V. Phone/Fax

Practice location:
  • Phone: 260-490-7337
  • Fax:
Mailing address:
  • Phone: 260-557-4349
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code363LP0200X
TaxonomyPediatric Nurse Practitioner
License Number28236383A
License Number StateIN

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: