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General NPI Number Information
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NPI Number | 1164475547
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Entity Type | Individual
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Provider Name | MELISSA RAE SCHMIDT PA-C
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Gender | Female
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Dates
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Enumeration Date | 05/18/2006
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Last Update Date | 04/09/2014
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Provider Practice Location Address
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Address Line | 205 VALLEY AVE
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City | WEST BEND
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State | WI
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Zip | 53095-5312
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Country | US
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Telephone | 262-338-1123
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Fax |
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Provider Business Mailing Address
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Address Line | 3003 W GOOD HOPE RD
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City | MILWAUKEE
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State | WI
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Zip | 53209-2042
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Country | US
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Telephone | 414-352-3100
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Fax |
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Authorized Official
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Title or Position |
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Name |
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Credential |
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Telephone |
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 363A00000X
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Taxonomy Name | Physician Assistant
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License Number | 1887
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License Number State | WI
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