Healthcare Provider Details

I. General information

NPI: 1780626879
Provider Name (Legal Business Name): NICOLE ANN SCHMIDT R-PAC
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 06/12/2006
Last Update Date: 09/05/2012
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

18 LIMESTONE DRIVE SUITE 5
WILLIAMSVILLE NY
14221
US

IV. Provider business mailing address

18 LIMESTONE DRIVE SUITE 5
WILLIAMSVILLE NY
14221
US

V. Phone/Fax

Practice location:
  • Phone: 716-632-1400
  • Fax: 716-632-5316
Mailing address:
  • Phone: 716-632-1400
  • Fax: 716-632-5316

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code363AS0400X
TaxonomySurgical Physician Assistant
License Number010347
License Number StateNY

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: