Healthcare Provider Details

I. General information

NPI: 1285628792
Provider Name (Legal Business Name): ERIN MELISSA SCHMIDTKE MSN
Entity Type: Individual
Gender: Female
Sole Proprietor: N

Provider Other Name: ERIN MELISSA RUEHLE MSN

II. Dates (important events)

Enumeration Date: 09/12/2005
Last Update Date: 07/08/2007
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

324 E 35TH ST
MINNEAPOLIS MN
55408-4580
US

IV. Provider business mailing address

5315 11TH AVE S
MINNEAPOLIS MN
55417-1831
US

V. Phone/Fax

Practice location:
  • Phone: 612-827-7181
  • Fax:
Mailing address:
  • Phone: 612-824-1075
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code363LF0000X
TaxonomyFamily Nurse Practitioner
License NumberR1556537
License Number StateMN

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: