Healthcare Provider Details

I. General information

NPI: 1114737202
Provider Name (Legal Business Name): WILLEM C SCHUTTE FNP-C
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 01/10/2025
Last Update Date: 01/10/2025
Certification Date: 01/08/2025
Deactivation Date:
Reactivation Date:

III. Provider practice location address

528 CHIEF EDDIE HOFFMAN HWY
BETHEL AK
99559
US

IV. Provider business mailing address

1032 SALMON RUN
FORT COLLINS CO
80524-8336
US

V. Phone/Fax

Practice location:
  • Phone: 907-543-6603
  • Fax:
Mailing address:
  • Phone: 808-384-9870
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code363LF0000X
TaxonomyFamily Nurse Practitioner
License NumberAPN.1000057-NP
License Number StateCO

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: