Provider Demographics
NPI:1033274303
Name:SCHMIDT, JACKEE DIANA
Entity type:Individual
Prefix:MISS
First Name:JACKEE
Middle Name:DIANA
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:ATTN CREDENTIALS OFFICE
Mailing Address - Street 2:CMR 442
Mailing Address - City:APO
Mailing Address - State:AE
Mailing Address - Zip Code:09042
Mailing Address - Country:DE
Mailing Address - Phone:49622-117-2274
Mailing Address - Fax:
Practice Address - Street 1:HEIDELBERG MEDDAC
Practice Address - Street 2:CMR 442
Practice Address - City:APO
Practice Address - State:AE
Practice Address - Zip Code:09042
Practice Address - Country:DE
Practice Address - Phone:49622-117-2274
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2006-12-27
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IL163WX0003X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes163WX0003XNursing Service ProvidersRegistered NurseObstetric, Inpatient