Healthcare Provider Details

I. General information

NPI: 1437895281
Provider Name (Legal Business Name): ANDY LEE SCHULTZ
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 05/05/2022
Last Update Date: 05/05/2022
Certification Date: 05/05/2022
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1877 WILLIAMS HWY
GRANTS PASS OR
97527-5802
US

IV. Provider business mailing address

1877 WILLIAMS HWY
GRANTS PASS OR
97527-5802
US

V. Phone/Fax

Practice location:
  • Phone: 541-955-5551
  • Fax: 541-955-7171
Mailing address:
  • Phone: 541-955-5551
  • Fax: 541-955-7171

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code163WP2201X
TaxonomyAmbulatory Care Registered Nurse
License Number201143201RN
License Number StateOR
# 2
Primary TaxonomyY
Taxonomy Code163WA2000X
TaxonomyAdministrator Registered Nurse
License Number201143201RN
License Number StateOR

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: