Healthcare Provider Details

I. General information

NPI: 1013795152
Provider Name (Legal Business Name): ANISHA KAMAL SCHULTZ
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 09/19/2023
Last Update Date: 10/27/2023
Certification Date: 10/14/2023
Deactivation Date:
Reactivation Date:

III. Provider practice location address

505 N CLIPPERT ST
LANSING MI
48912-4701
US

IV. Provider business mailing address

505 N CLIPPERT ST
LANSING MI
48912-4701
US

V. Phone/Fax

Practice location:
  • Phone: 952-465-2706
  • Fax:
Mailing address:
  • Phone: 952-465-2706
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code363LF0000X
TaxonomyFamily Nurse Practitioner
License Number4704404888
License Number StateMI

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: