Healthcare Provider Details

I. General information

NPI: 1891982641
Provider Name (Legal Business Name): HEATHER SCHULTZ CNP
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 09/26/2007
Last Update Date: 12/13/2016
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

123 E MAIN ST
AMANDA OH
43102-1111
US

IV. Provider business mailing address

1153 E MAIN ST PO BOX 2563
LANCASTER OH
43130-4056
US

V. Phone/Fax

Practice location:
  • Phone: 740-969-4828
  • Fax: 740-969-4818
Mailing address:
  • Phone: 740-687-8990
  • Fax: 740-687-8230

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code363LF0000X
TaxonomyFamily Nurse Practitioner
License NumberCOA.09588-NP
License Number StateOH
# 2
Primary TaxonomyN
Taxonomy Code363LA2200X
TaxonomyAdult Health Nurse Practitioner
License NumberCOA.09588-NP
License Number StateOH

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: