Basic Information
Provider Information
NPI: 1093893919
EntityType: 1
ReplacementNPI:  
OrganizationName:  
LastName: SCHMERTMANN
FirstName: ROXANNE
MiddleName: M
NamePrefix:  
NameSuffix:  
Credential: APN
OtherOrganizationName:  
OtherOrganizationType:  
OtherLastName: HIGLEY
OtherFirstName: ROXANNE
OtherMiddleName: M
OtherNamePrefix:  
OtherNameSuffix:  
OtherCredential:  
OtherLastNameType: 1
Mailing Information
Address1: 865 LINCOLN RD
Address2: STE L10
City: BETTENDORF
State: IA
PostalCode: 527224190
CountryCode: US
TelephoneNumber: 5633559191
FaxNumber: 5633553419
Practice Location
Address1: 855 ILLINI DR
Address2: STE 408
City: SILVIS
State: IL
PostalCode: 612822907
CountryCode: US
TelephoneNumber: 3097926441
FaxNumber: 3097927110
Other Information
ProviderEnumerationDate: 11/01/2006
LastUpdateDate: 07/08/2007
NPIDeactivationReasonCode:  
NPIDeactivationDate:  
NPIReactivationDate:  
ProviderGenderCode: F
AuthorizedOfficialLastName:  
AuthorizedOfficialFirstName:  
AuthorizedOfficialMiddleName:  
AuthorizedOfficialTitleorPosition:  
AuthorizedOfficialTelephone:  
IsSoleProprietor: N
IsOrganizationSubpart:  
ParentOrganizationLBN:  
AuthorizedOfficialNamePrefix:  
AuthorizedOfficialNameSuffix:  
AuthorizedOfficialCredential:  
NPICertificationDate:  

Taxonomy Information
TaxonomyLicenseStateSwitchTaxonomyGroupTaxonomyTypeTaxonomyClassSubSpecialty
363LW0102X ILY Physician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerWomen's Health

No ID Information.


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