Healthcare Provider Details

I. General information

NPI: 1568916708
Provider Name (Legal Business Name): KATELYN SHULTZ CRNA
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 08/04/2016
Last Update Date: 04/12/2017
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

2251 N SHORE DR
RHINELANDER WI
54501-6710
US

IV. Provider business mailing address

2538 EMILS WAY
RHINELANDER WI
54501-8030
US

V. Phone/Fax

Practice location:
  • Phone: 570-594-7412
  • Fax:
Mailing address:
  • Phone: 570-594-7412
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code163W00000X
TaxonomyRegistered Nurse
License NumberR 218101-1
License Number StateMN
# 2
Primary TaxonomyN
Taxonomy Code163W00000X
TaxonomyRegistered Nurse
License Number199089-30
License Number StateWI
# 3
Primary TaxonomyY
Taxonomy Code367500000X
TaxonomyCertified Registered Nurse Anesthetist
License NumberRN 199089-30
License Number StateWI

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: