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: 05/12/2011
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1031 BELLEVUE STE 280
ST. LOUIS MO
63114
US

IV. Provider business mailing address

PO BOX 23340
SAINT LOUIS MO
63156-3340
US

V. Phone/Fax

Practice location:
  • Phone: 314-647-9444
  • Fax: 314-647-7317
Mailing address:
  • Phone: 314-647-9444
  • Fax: 314-647-7317

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: