MEDICARE: MRS. SUSAN DISSELKOEN SCHMIDT NP

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	363LF0000X	Family Nurse Practitioner	91908	CO

Other Identifiers

#	Provider Identifier	Provider Identifier Type	Provider Identifier State	Provider Identifier Issuer
1	025437	OTHER	CO	KAISER COMMERCIAL NUMBER
2	MEDICAID ID Found: Get Medicaid Details using Online Medicaid Verification Program

General Provider Information

NPI Number	:	1750375226
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	MRS. SUSAN DISSELKOEN SCHMIDT NP

Provider Business Mailing Address
First Line	:	10350 E DAKOTA AVE
Second Line	:
City	:	DENVER
State	:	CO
Zip	:	80247-1314
Country	:	US
Telephone Number	:
Fax Number	:

Provider Business Practice Location Address
First Line	:	215 S PARKSIDE DR STE 215
Second Line	:
City	:	COLORADO SPRINGS
State	:	CO
Zip	:	80910-3131
Country	:	US
Telephone Number	:	303-338-4545
Fax Number	:

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

Provider Enumeration Date	:	09/09/2005
Last Update Date	:	06/21/2021

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