Healthcare Provider Details

I. General information

NPI: 1851346340
Provider Name (Legal Business Name): ELIZABETH A SCHMIDT P.A.-C
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 05/23/2006
Last Update Date: 12/28/2024
Certification Date: 12/28/2024
Deactivation Date:
Reactivation Date:

III. Provider practice location address

14040 NORTHDALE BLVD
ROGERS MN
55374-9612
US

IV. Provider business mailing address

6782 LAKEVIEW CIR
CORCORAN MN
55340-9798
US

V. Phone/Fax

Practice location:
  • Phone: 763-488-4100
  • Fax:
Mailing address:
  • Phone: 763-478-9102
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code363A00000X
TaxonomyPhysician Assistant
License Number8991
License Number StateMN
# 2
Primary TaxonomyY
Taxonomy Code363AM0700X
TaxonomyMedical Physician Assistant
License Number8991
License Number StateMN

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: