Healthcare Provider Details

I. General information

NPI: 1083643308
Provider Name (Legal Business Name): MARK E SCHULZ CRNA
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 06/30/2006
Last Update Date: 08/09/2023
Certification Date: 08/09/2023
Deactivation Date:
Reactivation Date:

III. Provider practice location address

401 9TH AVE NW
WATERTOWN SD
57201-1548
US

IV. Provider business mailing address

401 9TH AVE NW
WATERTOWN SD
57201-1548
US

V. Phone/Fax

Practice location:
  • Phone: 605-882-7000
  • Fax: 605-882-7636
Mailing address:
  • Phone: 605-882-7000
  • Fax: 605-882-7636

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code367500000X
TaxonomyCertified Registered Nurse Anesthetist
License NumberCRNA0510
License Number StateSD

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: