MEDICARE: MS. KELLY S. SHULTZ 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	363L00000X	Nurse Practitioner	UP004718B	PA

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	:	1467410340
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	MS. KELLY S. SHULTZ CRNP

Provider Business Mailing Address
First Line	:	215 E WATER ST
Second Line	:
City	:	MUNCY
State	:	PA
Zip	:	17756-8828
Country	:	US
Telephone Number	:
Fax Number	:

Provider Business Practice Location Address
First Line	:	215 E WATER ST
Second Line	:	SUSQUEHANNA HEALTH SKILLED NURSING & REHAB CENTER
City	:	MUNCY
State	:	PA
Zip	:	17756-8828
Country	:	US
Telephone Number	:	570-546-4040
Fax Number	:	570-546-4095

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

Provider Enumeration Date	:	05/02/2006
Last Update Date	:	02/02/2015

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