Provider Demographics
NPI:1386403293
Name:SCHMIDT, NICOLE HEATHER
Entity type:Individual
Prefix:
First Name:NICOLE
Middle Name:HEATHER
Last Name:SCHMIDT
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:117 E SOUTH ST
Mailing Address - Street 2:
Mailing Address - City:MARTINSBURG
Mailing Address - State:WV
Mailing Address - Zip Code:25401-4114
Mailing Address - Country:US
Mailing Address - Phone:223-205-8812
Mailing Address - Fax:
Practice Address - Street 1:117 E SOUTH ST
Practice Address - Street 2:
Practice Address - City:MARTINSBURG
Practice Address - State:WV
Practice Address - Zip Code:25401-4114
Practice Address - Country:US
Practice Address - Phone:223-205-8812
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2024-03-14
Last Update Date:2024-03-14
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes3747P1801XNursing Service Related ProvidersTechnicianPersonal Care Attendant