Basic Information
| Provider Information | |||||||||
| NPI: | 1568774834 | ||||||||
| EntityType: | 1 | ||||||||
| ReplacementNPI: | |||||||||
| OrganizationName: | |||||||||
| LastName: | RICKNER-SCHMIDT | ||||||||
| FirstName: | SHANNON | ||||||||
| MiddleName: | SEANA | ||||||||
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| Credential: | MD | ||||||||
| OtherOrganizationName: | |||||||||
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| OtherLastName: | RICKNER | ||||||||
| OtherFirstName: | SHANNON | ||||||||
| OtherMiddleName: | SEANA | ||||||||
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| OtherLastNameType: | 1 | ||||||||
| Mailing Information | |||||||||
| Address1: | PO BOX 845347 | ||||||||
| Address2: | |||||||||
| City: | DALLAS | ||||||||
| State: | TX | ||||||||
| PostalCode: | 752845347 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 2146483916 | ||||||||
| FaxNumber: | 2146488423 | ||||||||
| Practice Location | |||||||||
| Address1: | 5323 HARRY HINES BLVD | ||||||||
| Address2: | |||||||||
| City: | DALLAS | ||||||||
| State: | TX | ||||||||
| PostalCode: | 753907208 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 2146483916 | ||||||||
| FaxNumber: | 2146488423 | ||||||||
| Other Information | |||||||||
| ProviderEnumerationDate: | 07/02/2010 | ||||||||
| LastUpdateDate: | 09/16/2014 | ||||||||
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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 | 390200000X | MT198330 | PA | N | Student, Health Care | Student in an Organized Health Care Education/Training Program | 207P00000X | Q0551 | TX | Y | Allopathic & Osteopathic Physicians | Emergency Medicine |
No ID Information.