Healthcare Provider Details

I. General information

NPI: 1194816595
Provider Name (Legal Business Name): LISA SCHULTZ FNP
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 09/28/2006
Last Update Date: 08/28/2026
Certification Date: 08/28/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

9160 CLAYTON RD
SAINT LOUIS MO
63124-1874
US

IV. Provider business mailing address

9160 CLAYTON RD
SAINT LOUIS MO
63124-1874
US

V. Phone/Fax

Practice location:
  • Phone: 314-801-8898
  • Fax: 314-977-6837
Mailing address:
  • Phone: 314-801-8898
  • Fax: 314-977-6837

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code363LF0000X
TaxonomyFamily Nurse Practitioner
License Number141894
License Number StateMO

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: