Healthcare Provider Details

I. General information

NPI: 1649657271
Provider Name (Legal Business Name): TAMMY SHULTZ
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 05/04/2015
Last Update Date: 05/04/2015
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

172 KINSLEY ST
NASHUA NH
03060-3648
US

IV. Provider business mailing address

168 KINSLEY ST
NASHUA NH
03060-3634
US

V. Phone/Fax

Practice location:
  • Phone: 603-882-3000
  • Fax:
Mailing address:
  • Phone: 603-882-1501
  • Fax: 603-882-9747

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code367500000X
TaxonomyCertified Registered Nurse Anesthetist
License Number071392-23
License Number StateNH

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: