MEDICARE: SHERYL M SHANTZ FNP

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	363LF0000X	Family Nurse Practitioner	AP1852	AZ

Other Identifiers

#	Provider Identifier	Provider Identifier Type	Provider Identifier State	Provider Identifier Issuer
1	MEDICAID ID Found: Get Medicaid Details using Online Medicaid Verification Program

General Provider Information

NPI Number	:	1285613075
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	SHERYL M SHANTZ FNP

Provider Business Mailing Address
First Line	:	1865 W 21ST LN
Second Line	:
City	:	YUMA
State	:	AZ
Zip	:	85364-8833
Country	:	US
Telephone Number	:	928-819-0887
Fax Number	:

Provider Business Practice Location Address
First Line	:	1945 W 24TH ST
Second Line	:
City	:	YUMA
State	:	AZ
Zip	:	85364-6105
Country	:	US
Telephone Number	:	928-341-4650
Fax Number	:	928-341-9779

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

Provider Enumeration Date	:	01/11/2006
Last Update Date	:	07/09/2007

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