Healthcare Provider Details

I. General information

NPI: 1053017780
Provider Name (Legal Business Name): CHAD L SCHILTZ
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 02/03/2023
Last Update Date: 02/03/2023
Certification Date: 12/12/2022
Deactivation Date:
Reactivation Date:

III. Provider practice location address

301 NORTHERN PACIFIC AVE N
FARGO ND
58102-4835
US

IV. Provider business mailing address

522 MARTINS AVE N
CASSELTON ND
58012-3915
US

V. Phone/Fax

Practice location:
  • Phone: 701-271-3344
  • Fax:
Mailing address:
  • Phone: 701-899-0544
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code363LF0000X
TaxonomyFamily Nurse Practitioner
License NumberR43013
License Number StateND

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: