Provider Demographics
NPI:1861872129
Name:SCHMITZ, NICOLE
Entity type:Individual
Prefix:
First Name:NICOLE
Middle Name:
Last Name:SCHMITZ
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 1:9151 PELICAN LN
Mailing Address - Street 2:
Mailing Address - City:MONTICELLO
Mailing Address - State:MN
Mailing Address - Zip Code:55362-2856
Mailing Address - Country:US
Mailing Address - Phone:320-420-2600
Mailing Address - Fax:
Practice Address - Street 1:25 1ST AVE NE
Practice Address - Street 2:SUITE 100
Practice Address - City:BUFFALO
Practice Address - State:MN
Practice Address - Zip Code:55313-1568
Practice Address - Country:US
Practice Address - Phone:763-682-3005
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2015-06-02
Last Update Date:2015-06-02
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MNR2073815163W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes163W00000XNursing Service ProvidersRegistered Nurse