=====================================================
General NPI Number Information
=====================================================
NPI Number | 1396011029
-----------------------------------------------------
Entity Type | Organization
-----------------------------------------------------
Legal Business Name | JOSIE SCHMIDT ND LLC
-----------------------------------------------------
=====================================================
Dates
=====================================================
Enumeration Date | 03/27/2012
-----------------------------------------------------
Last Update Date | 03/27/2012
-----------------------------------------------------
=====================================================
Provider Practice Location Address
=====================================================
Address Line | 7 SE 30TH AVE
-----------------------------------------------------
City | PORTLAND
-----------------------------------------------------
State | OR
-----------------------------------------------------
Zip | 97214-1902
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 503-367-4964
-----------------------------------------------------
Fax |
-----------------------------------------------------
=====================================================
Provider Business Mailing Address
=====================================================
Address Line | 903 NE 72ND AVE
-----------------------------------------------------
City | PORTLAND
-----------------------------------------------------
State | OR
-----------------------------------------------------
Zip | 97213-6209
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 503-367-4964
-----------------------------------------------------
Fax |
-----------------------------------------------------
=====================================================
Authorized Official
=====================================================
Title or Position | OWNER
-----------------------------------------------------
Name | JOSIE HANNAH SCHMIDT
-----------------------------------------------------
Credential | ND
-----------------------------------------------------
Telephone | 503-367-4964
-----------------------------------------------------
=====================================================
Scope of Practice (Provider's specialty)
=====================================================
Taxonomy #1
-----------------------------------------------------
Taxonomy Code | 175F00000X
-----------------------------------------------------
Taxonomy Name | Naturopath
-----------------------------------------------------
License Number | 1132
-----------------------------------------------------
License Number State | OR
-----------------------------------------------------