Healthcare Provider Details

I. General information

NPI: 1861778771
Provider Name (Legal Business Name): SCOTT M SCHULTE CRNA
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 10/25/2011
Last Update Date: 11/07/2017
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

40 WEST ERIE ST STE 203
PAINESVILLE OH
44077
US

IV. Provider business mailing address

40 WEST ERIE ST STE 203
PAINESVILLE OH
44077
US

V. Phone/Fax

Practice location:
  • Phone: 440-350-0832
  • Fax: 440-354-7420
Mailing address:
  • Phone: 440-350-0832
  • Fax: 440-354-7420

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code367500000X
TaxonomyCertified Registered Nurse Anesthetist
License NumberAPRN.CRNA.12774
License Number StateOH

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: