Healthcare Provider Details

I. General information

NPI: 1932140167
Provider Name (Legal Business Name): NANCY LYNN SCHULLER APN
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 06/09/2006
Last Update Date: 02/20/2008
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

4238 PARK AVE
BROOKFIELD IL
60513-1910
US

IV. Provider business mailing address

4238 PARK AVE
BROOKFIELD IL
60513-1910
US

V. Phone/Fax

Practice location:
  • Phone: 708-387-9339
  • Fax:
Mailing address:
  • Phone: 708-387-9339
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code364SM0705X
TaxonomyMedical-Surgical Clinical Nurse Specialist
License Number
License Number StateIL

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: