Basic Information
Provider Information
NPI: 1982112082
EntityType: 1
ReplacementNPI:  
OrganizationName:  
LastName: SCHMIDT
FirstName: NANCY
MiddleName: W
NamePrefix:  
NameSuffix:  
Credential: LD
OtherOrganizationName:  
OtherOrganizationType:  
OtherLastName:  
OtherFirstName:  
OtherMiddleName:  
OtherNamePrefix:  
OtherNameSuffix:  
OtherCredential:  
OtherLastNameType:  
Mailing Information
Address1: 4685 FOREST AVE
Address2:  
City: CINCINNATI
State: OH
PostalCode: 452123397
CountryCode: US
TelephoneNumber: 5138534722
FaxNumber: 5138528525
Practice Location
Address1: 5520 CHEVIOT RD
Address2:  
City: CINCINNATI
State: OH
PostalCode: 452477069
CountryCode: US
TelephoneNumber: 5134514033
FaxNumber: 5134511356
Other Information
ProviderEnumerationDate: 01/11/2018
LastUpdateDate: 01/11/2018
NPIDeactivationReasonCode:  
NPIDeactivationDate:  
NPIReactivationDate:  
ProviderGenderCode: F
AuthorizedOfficialLastName:  
AuthorizedOfficialFirstName:  
AuthorizedOfficialMiddleName:  
AuthorizedOfficialTitleorPosition:  
AuthorizedOfficialTelephone:  
IsSoleProprietor: Y
IsOrganizationSubpart:  
ParentOrganizationLBN:  
AuthorizedOfficialNamePrefix:  
AuthorizedOfficialNameSuffix:  
AuthorizedOfficialCredential:  
NPICertificationDate:  

Taxonomy Information
TaxonomyLicenseStateSwitchTaxonomyGroupTaxonomyTypeTaxonomyClassSubSpecialty
133VN1004XLD2262OHY Dietary & Nutritional Service ProvidersDietitian, RegisteredNutrition, Pediatric

No ID Information.


Home