Provider Demographics
NPI:1306129309
Name:SCHMIDT, MARY DRUCILLA (LPN)
Entity type:Individual
Prefix:
First Name:MARY
Middle Name:DRUCILLA
Last Name:SCHMIDT
Suffix:
Gender:F
Credentials:LPN
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:2511 HIAWATHA ST
Mailing Address - Street 2:
Mailing Address - City:COLUMBUS
Mailing Address - State:OH
Mailing Address - Zip Code:43211
Mailing Address - Country:US
Mailing Address - Phone:614-330-3583
Mailing Address - Fax:
Practice Address - Street 1:2511 HIAWATHA ST
Practice Address - Street 2:
Practice Address - City:COLUMBUS
Practice Address - State:OH
Practice Address - Zip Code:43211-1165
Practice Address - Country:US
Practice Address - Phone:614-330-3583
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2011-09-26
Last Update Date:2011-09-26
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OH133722164W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes164W00000XNursing Service ProvidersLicensed Practical Nurse