Healthcare Provider Details

I. General information

NPI: 1073248951
Provider Name (Legal Business Name): TRAVIS RANDAL SCHULZE CRNA
Entity Type: Individual
Gender: Male
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 07/23/2022
Last Update Date: 12/18/2025
Certification Date: 12/18/2025
Deactivation Date:
Reactivation Date:

III. Provider practice location address

712 W MAIN ST
MANCHESTER IA
52057-1525
US

IV. Provider business mailing address

22399 186TH AVE
MANCHESTER IA
52057-8682
US

V. Phone/Fax

Practice location:
  • Phone: 563-822-1435
  • Fax: 563-822-1436
Mailing address:
  • Phone: 318-272-9888
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code163W00000X
TaxonomyRegistered Nurse
License Number2019031860
License Number StateMO
# 2
Primary TaxonomyY
Taxonomy Code367500000X
TaxonomyCertified Registered Nurse Anesthetist
License Number175009
License Number StateIA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: