Healthcare Provider Details

I. General information

NPI: 1093807547
Provider Name (Legal Business Name): MARJORIE A SCHMIDT PA-C
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 09/29/2006
Last Update Date: 07/08/2007
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

807 N ASH ST
GORDON NE
69343-1132
US

IV. Provider business mailing address

807 N ASH ST
GORDON NE
69343-1132
US

V. Phone/Fax

Practice location:
  • Phone: 308-282-1442
  • Fax: 308-282-1428
Mailing address:
  • Phone: 308-282-1442
  • Fax: 308-282-1428

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code363AM0700X
TaxonomyMedical Physician Assistant
License Number655
License Number StateNE

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: