Healthcare Provider Details

I. General information

NPI: 1962314047
Provider Name (Legal Business Name): MAQUENZIE SCHULTZ FNP-BC
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 09/22/2026
Last Update Date: 09/22/2026
Certification Date: 09/22/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

2600 FERRY ST
LAFAYETTE IN
47904-3055
US

IV. Provider business mailing address

835 BELGIAN LN
LAFAYETTE IN
47905-0794
US

V. Phone/Fax

Practice location:
  • Phone: 765-838-6811
  • Fax:
Mailing address:
  • Phone: 765-586-2137
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code363LF0000X
TaxonomyFamily Nurse Practitioner
License Number2026037216
License Number StateIN

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: