Healthcare Provider Details

I. General information

NPI: 1780486308
Provider Name (Legal Business Name): JESSICA SCHMIDT RN
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 03/25/2025
Last Update Date: 03/25/2025
Certification Date: 03/25/2025
Deactivation Date:
Reactivation Date:

III. Provider practice location address

3200 W LIBERTY RD STE A
ANN ARBOR MI
48103-9794
US

IV. Provider business mailing address

58560 STUART DR
SOUTH LYON MI
48178-3705
US

V. Phone/Fax

Practice location:
  • Phone: 734-994-5858
  • Fax:
Mailing address:
  • Phone: 919-452-0900
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code163WP0200X
TaxonomyPediatric Registered Nurse
License Number4704415080
License Number StateMI

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: