Basic Information
Provider Information
NPI: 1639304678
EntityType: 1
ReplacementNPI:  
OrganizationName:  
LastName: SCHMIDT
FirstName: RHONDA
MiddleName:  
NamePrefix:  
NameSuffix:  
Credential: ADVANCED NURSE PRACT
OtherOrganizationName:  
OtherOrganizationType:  
OtherLastName:  
OtherFirstName:  
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OtherNamePrefix:  
OtherNameSuffix:  
OtherCredential:  
OtherLastNameType:  
Mailing Information
Address1: 1380 RIVER BEND DR.
Address2:  
City: DALLAS
State: TX
PostalCode: 75247
CountryCode: US
TelephoneNumber: 2147436159
FaxNumber:  
Practice Location
Address1: 1380 RIVER BEND DR.
Address2:  
City: DALLAS
State: TX
PostalCode: 75247
CountryCode: US
TelephoneNumber: 2147436159
FaxNumber:  
Other Information
ProviderEnumerationDate: 05/20/2009
LastUpdateDate: 09/10/2010
NPIDeactivationReasonCode:  
NPIDeactivationDate:  
NPIReactivationDate:  
ProviderGenderCode: F
AuthorizedOfficialLastName:  
AuthorizedOfficialFirstName:  
AuthorizedOfficialMiddleName:  
AuthorizedOfficialTitleorPosition:  
AuthorizedOfficialTelephone:  
IsSoleProprietor: N
IsOrganizationSubpart:  
ParentOrganizationLBN:  
AuthorizedOfficialNamePrefix:  
AuthorizedOfficialNameSuffix:  
AuthorizedOfficialCredential:  
NPICertificationDate:  

Taxonomy Information
TaxonomyLicenseStateSwitchTaxonomyGroupTaxonomyTypeTaxonomyClassSubSpecialty
363LP0808X500456TXY Physician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerPsych/Mental Health

No ID Information.


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