Healthcare Provider Details

I. General information

NPI: 1144220070
Provider Name (Legal Business Name): KELLI LYNN SCHULTZ NP
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 07/21/2005
Last Update Date: 02/17/2010
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

240 N BLUFF BLVD SUITE 200
CLINTON IA
52732-7160
US

IV. Provider business mailing address

240 N BLUFF BLVD SUITE 200
CLINTON IA
52732-7160
US

V. Phone/Fax

Practice location:
  • Phone: 563-243-0100
  • Fax: 563-243-0550
Mailing address:
  • Phone: 563-243-0100
  • Fax: 563-243-0550

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code363LF0000X
TaxonomyFamily Nurse Practitioner
License NumberA-088179
License Number StateIA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: