=====================================================
General NPI Number Information
=====================================================
NPI Number | 1245044908
-----------------------------------------------------
Entity Type | Individual
-----------------------------------------------------
Provider Name | ANDREA SCHMITZ
-----------------------------------------------------
Gender | Female
-----------------------------------------------------
=====================================================
Dates
=====================================================
Enumeration Date | 02/04/2025
-----------------------------------------------------
Last Update Date | 02/04/2025
-----------------------------------------------------
=====================================================
Provider Practice Location Address
=====================================================
Address Line | 324 S HALL ST
-----------------------------------------------------
City | VALENTINE
-----------------------------------------------------
State | NE
-----------------------------------------------------
Zip | 69201-2156
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 402-376-2900
-----------------------------------------------------
Fax |
-----------------------------------------------------
=====================================================
Provider Business Mailing Address
=====================================================
Address Line | 30019 S SCALP RD
-----------------------------------------------------
City | FAIRFAX
-----------------------------------------------------
State | SD
-----------------------------------------------------
Zip | 57335-5322
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 605-830-2432
-----------------------------------------------------
Fax |
-----------------------------------------------------
=====================================================
Authorized Official
=====================================================
Title or Position |
-----------------------------------------------------
Name |
-----------------------------------------------------
Credential |
-----------------------------------------------------
Telephone |
-----------------------------------------------------
=====================================================
Scope of Practice (Provider's specialty)
=====================================================
Taxonomy #1
-----------------------------------------------------
Taxonomy Code | 163WG0000X
-----------------------------------------------------
Taxonomy Name | General Practice Registered Nurse
-----------------------------------------------------
License Number | R054382
-----------------------------------------------------
License Number State | SD
-----------------------------------------------------