Healthcare Provider Details

I. General information

NPI: 1932234614
Provider Name (Legal Business Name): KATHERINE ANNE SCHMID RD
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 02/22/2007
Last Update Date: 12/29/2012
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

11193 GLEN AVON WAY
ZIONSVILLE IN
46077-1287
US

IV. Provider business mailing address

11193 GLEN AVON WAY
ZIONSVILLE IN
46077-1287
US

V. Phone/Fax

Practice location:
  • Phone: 847-867-6942
  • Fax: 317-344-0265
Mailing address:
  • Phone: 847-867-6942
  • Fax: 317-344-0265

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code133V00000X
TaxonomyRegistered Dietitian
License Number164002523
License Number StateIL

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: