Provider Demographics
NPI:1154872737
Name:SCHMIDT, DEBORAH ANNETTE (LVN)
Entity type:Individual
Prefix:MS
First Name:DEBORAH
Middle Name:ANNETTE
Last Name:SCHMIDT
Suffix:
Gender:F
Credentials:LVN
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:10010 SKY CT
Mailing Address - Street 2:A
Mailing Address - City:KELSEYVILLE
Mailing Address - State:CA
Mailing Address - Zip Code:95451-9514
Mailing Address - Country:US
Mailing Address - Phone:559-978-8555
Mailing Address - Fax:
Practice Address - Street 1:6302 13TH AVE.
Practice Address - Street 2:
Practice Address - City:LUCERNE
Practice Address - State:CA
Practice Address - Zip Code:95458
Practice Address - Country:US
Practice Address - Phone:707-274-9101
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2016-10-19
Last Update Date:2016-10-19
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CAVN 207972164X00000X
CAVN207972164X00000X, 310500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes164X00000XNursing Service ProvidersLicensed Vocational Nurse
No310500000XNursing & Custodial Care FacilitiesIntermediate Care Facility, Mental Illness