Healthcare Provider Details

I. General information

NPI: 1477071892
Provider Name (Legal Business Name): CONSTANCE KAY SCHMIDT CNS
Entity Type: Individual
Gender: Female
Sole Proprietor: N

Provider Other Name: CONNIE KOOIMAN CNS

II. Dates (important events)

Enumeration Date: 09/06/2017
Last Update Date: 06/21/2018
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1305 W 18TH ST
SIOUX FALLS SD
57105
US

IV. Provider business mailing address

30371 473RD AVE
BERESFORD SD
57004-6934
US

V. Phone/Fax

Practice location:
  • Phone: 605-328-5246
  • Fax:
Mailing address:
  • Phone: 605-328-5246
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code363LF0000X
TaxonomyFamily Nurse Practitioner
License NumberCP000311
License Number StateSD
# 2
Primary TaxonomyN
Taxonomy Code364S00000X
TaxonomyClinical Nurse Specialist
License NumberCS004100
License Number StateSD

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: