Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 207Y00000X | Otolaryngologist (ENT Doctor) | 86917 | GA |
N | 207Y00000X | Otolaryngologist (ENT Doctor) | ACS11006 | AL |
N | 207Y00000X | Otolaryngologist (ENT Doctor) | G161068 | CA |
NPI | 1063486546 |
---|---|
Provider Name | Kim Elaine Schmitt |
First Address | Santa Rosa, CA 95403-3634 |
Second Address | Santa Rosa, CA 95404 |
Gender | F |
NPI Entity type | Individual |
Is Sole Proprietor | No |
Is Organization Subpart | N/A |
Enumeration Date | 14/02/2006 |
Last Update Date | 19/11/2020 |
IDENTIFIER | TYPE / CODE | IDENTIFIER STATE |
---|---|---|
D64680 | (02) | AL |