Provider Demographics
NPI:1447377197
Name:SCHMID DAVIS, NICOLE M (PAC)
Entity type:Individual
Prefix:
First Name:NICOLE
Middle Name:M
Last Name:SCHMID DAVIS
Suffix:
Gender:F
Credentials:PAC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1445 WHITEHORSE MERCERVILLE RD STE 103
Mailing Address - Street 2:
Mailing Address - City:HAMILTON
Mailing Address - State:NJ
Mailing Address - Zip Code:08619-3834
Mailing Address - Country:US
Mailing Address - Phone:609-587-6661
Mailing Address - Fax:609-587-8503
Practice Address - Street 1:1445 WHITEHORSE MERCERVILLE RD STE 103
Practice Address - Street 2:
Practice Address - City:HAMILTON
Practice Address - State:NJ
Practice Address - Zip Code:08619-3834
Practice Address - Country:US
Practice Address - Phone:609-587-6661
Practice Address - Fax:609-587-8503
Is Sole Proprietor?:No
Enumeration Date:2007-03-26
Last Update Date:2018-03-17
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
PAMA002685L363A00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363A00000XPhysician Assistants & Advanced Practice Nursing ProvidersPhysician Assistant