Healthcare Provider Details

I. General information

NPI: 1619911559
Provider Name (Legal Business Name): CRAIG SCHULTZ
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 06/15/2006
Last Update Date: 05/14/2019
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

301 NE KNOTT ST
PORTLAND OR
97212-3014
US

IV. Provider business mailing address

301 NE KNOTT ST
PORTLAND OR
97212-3014
US

V. Phone/Fax

Practice location:
  • Phone: 503-253-3910
  • Fax: 503-253-4297
Mailing address:
  • Phone: 503-253-3910
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code207N00000X
TaxonomyDermatology Physician
License Number099007734RN
License Number StateOR
# 2
Primary TaxonomyN
Taxonomy Code363L00000X
TaxonomyNurse Practitioner
License NumberAP30005962
License Number StateWA
# 3
Primary TaxonomyY
Taxonomy Code363L00000X
TaxonomyNurse Practitioner
License Number200150081NP
License Number StateOR

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: