Basic Information
| Provider Information | |||||||||
| NPI: | 1902257454 | ||||||||
| EntityType: | 1 | ||||||||
| ReplacementNPI: | |||||||||
| OrganizationName: | |||||||||
| LastName: | SCHMIDT | ||||||||
| FirstName: | JENNY | ||||||||
| MiddleName: | |||||||||
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| Mailing Information | |||||||||
| Address1: | 401 N 9TH ST | ||||||||
| Address2: | |||||||||
| City: | BISMARCK | ||||||||
| State: | ND | ||||||||
| PostalCode: | 585014530 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 7017124500 | ||||||||
| FaxNumber: | 7017124098 | ||||||||
| Practice Location | |||||||||
| Address1: | 401 N 9TH ST | ||||||||
| Address2: | |||||||||
| City: | BISMARCK | ||||||||
| State: | ND | ||||||||
| PostalCode: | 585014530 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 7015306000 | ||||||||
| FaxNumber: | |||||||||
| Other Information | |||||||||
| ProviderEnumerationDate: | 06/27/2016 | ||||||||
| LastUpdateDate: | 11/10/2021 | ||||||||
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| ProviderGenderCode: | F | ||||||||
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| IsSoleProprietor: | N | ||||||||
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| NPICertificationDate: | 11/10/2021 | ||||||||
Taxonomy Information
| Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 133V00000X | 971 | ND | Y | Dietary & Nutritional Service Providers | Dietitian, Registered |
ID Information
| ID | Type | State | Issuer | Description | 971 | 01 | ND | LICENSE | OTHER |