MEDICARE: DIANE MONICA SCHMITZ PA-C

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	363A00000X	Physician Assistant	PA195972	OR

General Provider Information

NPI Number	:	1497238273
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	DIANE MONICA SCHMITZ PA-C

Provider Business Mailing Address
First Line	:	2055 MYRTLE AVE NE
Second Line	:
City	:	SALEM
State	:	OR
Zip	:	97301-7269
Country	:	US
Telephone Number	:	509-979-6761
Fax Number	:

Provider Business Practice Location Address
First Line	:	960 LIBERTY ST SE STE 200
Second Line	:
City	:	SALEM
State	:	OR
Zip	:	97302-4195
Country	:	US
Telephone Number	:	503-399-0652
Fax Number	:	503-373-3852

Authorized Official
Title or Position	:
Name	:
Credential	:
Telephone Number	:

Provider Enumeration Date	:	09/08/2018
Last Update Date	:	12/06/2019

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Directions to “ DIANE MONICA SCHMITZ PA-C” Practice Location

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