MEDICARE: JESSICA SCHMIDT RN

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	163WP0200X	Pediatric Registered Nurse	4704415080	MI

General Provider Information

NPI Number	:	1780486308
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	JESSICA SCHMIDT RN

Provider Business Mailing Address
First Line	:	58560 STUART DR
Second Line	:
City	:	SOUTH LYON
State	:	MI
Zip	:	48178-3705
Country	:	US
Telephone Number	:	919-452-0900
Fax Number	:

Provider Business Practice Location Address
First Line	:	3200 W LIBERTY RD STE A
Second Line	:
City	:	ANN ARBOR
State	:	MI
Zip	:	48103-9794
Country	:	US
Telephone Number	:	734-994-5858
Fax Number	:

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

Provider Enumeration Date	:	03/25/2025
Last Update Date	:	03/25/2025

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