MEDICARE: MISS EMILY THERESA SCHULTZ CRNP

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	363LA2200X	Adult Health Nurse Practitioner	173931	MD
2	363LG0600X	Gerontology Nurse Practitioner	173931	MD

General Provider Information

NPI Number	:	1053755140
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	MISS EMILY THERESA SCHULTZ CRNP

Provider Business Mailing Address
First Line	:	3403 ODONNELL ST
Second Line	:
City	:	BALTIMORE
State	:	MD
Zip	:	21224-5117
Country	:	US
Telephone Number	:	443-521-4784
Fax Number	:

Provider Business Practice Location Address
First Line	:	800 SOUTHERLY RD
Second Line	:
City	:	TOWSON
State	:	MD
Zip	:	21286-8403
Country	:	US
Telephone Number	:	410-339-6251
Fax Number	:

Authorized Official
Title or Position	:
Name	:
Credential	:
Telephone Number	:

Provider Enumeration Date	:	04/19/2013
Last Update Date	:	08/03/2015

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