Basic Information
| Provider Information | |||||||||
| NPI: | 1609350131 | ||||||||
| EntityType: | 1 | ||||||||
| ReplacementNPI: | |||||||||
| OrganizationName: | |||||||||
| LastName: | SCHMIDT | ||||||||
| FirstName: | MOLLY | ||||||||
| MiddleName: | WENZEL | ||||||||
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| Credential: | DNP, RN, CRNA | ||||||||
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| Mailing Information | |||||||||
| Address1: | 680 N. LAKE SHORE DRIVE | ||||||||
| Address2: | SUITE 1000 | ||||||||
| City: | CHICAGO | ||||||||
| State: | IL | ||||||||
| PostalCode: | 606118709 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 3126950665 | ||||||||
| FaxNumber: | 3126956594 | ||||||||
| Practice Location | |||||||||
| Address1: | 251 E HURON ST STE 5-704 | ||||||||
| Address2: | FEINBERG PAVILION | ||||||||
| City: | CHICAGO | ||||||||
| State: | IL | ||||||||
| PostalCode: | 606113055 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 3126950665 | ||||||||
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| Other Information | |||||||||
| ProviderEnumerationDate: | 09/20/2018 | ||||||||
| LastUpdateDate: | 12/13/2018 | ||||||||
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| ProviderGenderCode: | F | ||||||||
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| IsSoleProprietor: | N | ||||||||
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Taxonomy Information
| Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 390200000X | IL | N | Student, Health Care | Student in an Organized Health Care Education/Training Program | 367500000X | 209.018467 | IL | Y | Physician Assistants & Advanced Practice Nursing Providers | Nurse Anesthetist, Certified Registered |
No ID Information.