Healthcare Provider Details

I. General information

NPI: 1245493642
Provider Name (Legal Business Name): MRS. DENISE ELAINE SCHUTTIG
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 07/07/2008
Last Update Date: 07/07/2008
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

202 NE EASTWOOD DR
BLUE SPRINGS MO
64014
US

IV. Provider business mailing address

202 NE EASTWOOD DR
BLUE SPRINGS MO
64014-2679
US

V. Phone/Fax

Practice location:
  • Phone: 816-228-9659
  • Fax:
Mailing address:
  • Phone: 816-228-9659
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code163W00000X
TaxonomyRegistered Nurse
License Number070058
License Number StateMO

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: