1477349215 NPI number — MRS. ALEXIS BRIANNA SCHMIT BURDETT

Table of content: MRS. ALEXIS BRIANNA SCHMIT BURDETT (NPI 1477349215)

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1477349215 NPI number — MRS. ALEXIS BRIANNA SCHMIT BURDETT

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
Provider Last Name:
BURDETT
Provider First Name:
ALEXIS
Provider Middle Name:
BRIANNA SCHMIT
Provider Name Prefix Text:
MRS.
Provider Name Suffix Text:
Provider Credential Text:
Provider Gender Code:
F

Provider's Other Name Information

Provider Other Organization Name:
Provider Other Organization Name Type Code:
Provider Other Last Name:
Provider Other First Name:
Provider Other Middle Name:
Provider Other Name Prefix Text:
Provider Other Name Suffix Text:
Provider Other Credential Text:
Provider Other Last Name Type Code:

NPI Number Information

NPI Number:
1477349215
Entity Type Code:
Individual
Replacement NPI:
Last Update Date:
04/17/2025
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
31108 DANDER LN
Provider Second Line Business Mailing Address:
Provider Business Mailing Address City Name:
GENOA
Provider Business Mailing Address State Name:
IL
Provider Business Mailing Address Postal Code:
60135-8062
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
815-766-1798
Provider Business Mailing Address Fax Number:

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
155 N 3RD ST FL 5
Provider Second Line Business Practice Location Address:
Provider Business Practice Location Address City Name:
DEKALB
Provider Business Practice Location Address State Name:
IL
Provider Business Practice Location Address Postal Code:
60115-3366
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
815-418-2476
Provider Business Practice Location Address Fax Number:
Provider Enumeration Date:
04/17/2025

Additional Information

Authorized Official

Authorized Official Last Name:
Authorized Official First Name:
Authorized Official Middle Name:
Authorized Official Title or Position:
Authorized Official Telephone Number:

Provider Taxonomy Codes

  • Taxonomy code: 374J00000X ; information, associated with the NPI states the following Primary Taxonomy Switch: "Y" .

Other Provider's Identifiers (legacy, non-NPI)





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