Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 103G00000X | Clinical Psychologist | PY0528 | NV |
Y | 103TC0700X | Clinical Psychologist | PY0528 | NV |
NPI | 1003976978 |
---|---|
Provider Name | Cynthia Schmidt |
First Address | Nellis Afb, NV 89191-6600 |
Second Address | Nellis Afb, NV 89191-6600 |
Gender | F |
NPI Entity type | Individual |
Is Sole Proprietor | Yes |
Is Organization Subpart | N/A |
Enumeration Date | 11/12/2006 |
Last Update Date | 07/01/2014 |
IDENTIFIER | TYPE / CODE | IDENTIFIER STATE |
---|---|---|
100511224 | (05) | NV |
CQ435Z | MEDICARE PTAN (01) | NV |