=====================================================
General NPI Number Information
=====================================================
NPI Number | 1942343645
-----------------------------------------------------
Entity Type | Individual
-----------------------------------------------------
Provider Name | TIMOTHY D SCHMIDT CRNA
-----------------------------------------------------
Gender | Male
-----------------------------------------------------
=====================================================
Dates
=====================================================
Enumeration Date | 02/14/2007
-----------------------------------------------------
Last Update Date | 07/08/2007
-----------------------------------------------------
=====================================================
Provider Practice Location Address
=====================================================
Address Line | 819 ASH ST SPOONER HEALTH SYSTEM
-----------------------------------------------------
City | SPOONER
-----------------------------------------------------
State | WI
-----------------------------------------------------
Zip | 54801-1201
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 715-635-2111
-----------------------------------------------------
Fax |
-----------------------------------------------------
=====================================================
Provider Business Mailing Address
=====================================================
Address Line | W6840 RYDBERG RD
-----------------------------------------------------
City | SPOONER
-----------------------------------------------------
State | WI
-----------------------------------------------------
Zip | 54801-7677
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 715-635-2313
-----------------------------------------------------
Fax |
-----------------------------------------------------
=====================================================
Authorized Official
=====================================================
Title or Position |
-----------------------------------------------------
Name |
-----------------------------------------------------
Credential |
-----------------------------------------------------
Telephone |
-----------------------------------------------------
=====================================================
Scope of Practice (Provider's specialty)
=====================================================
Taxonomy #1
-----------------------------------------------------
Taxonomy Code | 367500000X
-----------------------------------------------------
Taxonomy Name | Certified Registered Nurse Anesthetist
-----------------------------------------------------
License Number | 80860-030
-----------------------------------------------------
License Number State | WI
-----------------------------------------------------