Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 207Q00000X | Family Doctor | 04-36789 | KS |
NPI | 1003174814 |
---|---|
Provider Name | Alisa L Schmidt |
First Address | Wichita, KS 67208-4500 |
Second Address | Wichita, KS 67208 |
Gender | F |
NPI Entity type | Individual |
Is Sole Proprietor | No |
Is Organization Subpart | N/A |
Enumeration Date | 30/04/2012 |
Last Update Date | 06/05/2019 |
IDENTIFIER | TYPE / CODE | IDENTIFIER STATE |
---|---|---|
04-36789 | KANSAS LICENSE (01) | KS |
201110460B | (05) | KS |