Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
N | 207QS0010X | Family Doctor - Sports Medicine | 63924 | MN |
Y | 208000000X | Pediatrician | 63924 | MN |
NPI | 1144617366 |
---|---|
Provider Name | Mckayla Schmitt |
First Address | Bloomington, MN 55425-4516 |
Second Address | Bloomington, MN 55431-4800 |
Gender | F |
NPI Entity type | Individual |
Is Sole Proprietor | No |
Is Organization Subpart | N/A |
Enumeration Date | 26/04/2015 |
Last Update Date | 16/07/2021 |