MEDICARE: PAULINE SCHULTZ CRNA

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	367500000X	Certified Registered Nurse Anesthetist	209003700	IL

General Provider Information

NPI Number	:	1891797312
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	PAULINE SCHULTZ CRNA

Provider Business Mailing Address
First Line	:	19624 GOVERNORS HWY
Second Line	:
City	:	FLOSSMOOR
State	:	IL
Zip	:	60422-2077
Country	:	US
Telephone Number	:	708-798-5838
Fax Number	:	708-798-5865

Provider Business Practice Location Address
First Line	:	19624 GOVERNORS HWY
Second Line	:
City	:	FLOSSMOOR
State	:	IL
Zip	:	60422-2077
Country	:	US
Telephone Number	:	708-798-5838
Fax Number	:	708-798-5865

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

Provider Enumeration Date	:	08/15/2005
Last Update Date	:	12/23/2011

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