Healthcare Provider Details

I. General information

NPI: 1104393909
Provider Name (Legal Business Name): MARYELLEN SCHULTZE RN
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 10/30/2018
Last Update Date: 10/30/2018
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

905 W GOVERNOR RD
HERSHEY PA
17033-2307
US

IV. Provider business mailing address

2537 BLARNEY DR
HARRISBURG PA
17112-8616
US

V. Phone/Fax

Practice location:
  • Phone: 717-531-8521
  • Fax:
Mailing address:
  • Phone: 717-350-1807
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code163WD0400X
TaxonomyDiabetes Educator Registered Nurse
License NumberRN343962L
License Number StatePA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: