Basic Information
| Provider Information | |||||||||
| NPI: | 1356907778 | ||||||||
| EntityType: | 1 | ||||||||
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| OrganizationName: | |||||||||
| LastName: | SCHMITZ | ||||||||
| FirstName: | KAREN | ||||||||
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| Mailing Information | |||||||||
| Address1: | 740 N 15TH AVE STE A | ||||||||
| Address2: | |||||||||
| City: | HIAWATHA | ||||||||
| State: | IA | ||||||||
| PostalCode: | 522332384 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 3193983562 | ||||||||
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| Practice Location | |||||||||
| Address1: | 721 S 5TH ST | ||||||||
| Address2: | |||||||||
| City: | MANCHESTER | ||||||||
| State: | IA | ||||||||
| PostalCode: | 520572048 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 5639276700 | ||||||||
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| Other Information | |||||||||
| ProviderEnumerationDate: | 05/10/2019 | ||||||||
| LastUpdateDate: | 05/10/2019 | ||||||||
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| ProviderGenderCode: | F | ||||||||
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| IsSoleProprietor: | N | ||||||||
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Taxonomy Information
| Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 363LP0808X | G154409 | IA | Y | Physician Assistants & Advanced Practice Nursing Providers | Nurse Practitioner | Psych/Mental Health |
ID Information
| ID | Type | State | Issuer | Description | 0074575 | 05 | IA | MEDICAID |