MEDICARE: MARY ROCHELLE SCHULTZ RN-CPNP

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	363LP0200X	Pediatric Nurse Practitioner	545024	TX

General Provider Information

NPI Number	:	1114194206
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	MARY ROCHELLE SCHULTZ RN-CPNP

Provider Business Mailing Address
First Line	:	18057 HIGHWAY 105 W STE 220
Second Line	:
City	:	MONTGOMERY
State	:	TX
Zip	:	77356-5985
Country	:	US
Telephone Number	:	936-582-5620
Fax Number	:	936-582-5621

Provider Business Practice Location Address
First Line	:	18057 HIGHWAY 105 W STE 220
Second Line	:
City	:	MONTGOMERY
State	:	TX
Zip	:	77356-5985
Country	:	US
Telephone Number	:	936-582-5620
Fax Number	:	936-582-5621

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

Provider Enumeration Date	:	05/08/2008
Last Update Date	:	05/08/2008

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