=====================================================
General NPI Number Information
=====================================================
NPI Number | 1053826354
-----------------------------------------------------
Entity Type | Organization
-----------------------------------------------------
Legal Business Name | NURSE PRACTITIONERS R US
-----------------------------------------------------
=====================================================
Dates
=====================================================
Enumeration Date | 12/08/2017
-----------------------------------------------------
Last Update Date | 05/14/2018
-----------------------------------------------------
=====================================================
Provider Practice Location Address
=====================================================
Address Line | 4555 E MAYO BLVD
-----------------------------------------------------
City | PHOENIX
-----------------------------------------------------
State | AZ
-----------------------------------------------------
Zip | 85050
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 602-883-3647
-----------------------------------------------------
Fax |
-----------------------------------------------------
=====================================================
Provider Business Mailing Address
=====================================================
Address Line | 3944 E HILLERY DR
-----------------------------------------------------
City | PHOENIX
-----------------------------------------------------
State | AZ
-----------------------------------------------------
Zip | 85032-5245
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 602-883-3647
-----------------------------------------------------
Fax | 602-795-6302
-----------------------------------------------------
=====================================================
Authorized Official
=====================================================
Title or Position | CO-OWNER
-----------------------------------------------------
Name | DR. KELLY LYNN SCHULTZ
-----------------------------------------------------
Credential | DNP
-----------------------------------------------------
Telephone | 602-883-3647
-----------------------------------------------------
=====================================================
Scope of Practice (Provider's specialty)
=====================================================
Taxonomy #1
-----------------------------------------------------
Taxonomy Code | 163WW0000X
-----------------------------------------------------
Taxonomy Name | Wound Care Registered Nurse
-----------------------------------------------------
License Number |
-----------------------------------------------------
License Number State | AZ
-----------------------------------------------------
Taxonomy #2
-----------------------------------------------------
Taxonomy Code | 207RG0300X
-----------------------------------------------------
Taxonomy Name | Geriatric Medicine (Internal Medicine) Physician
-----------------------------------------------------
License Number | AP7985
-----------------------------------------------------
License Number State | AZ
-----------------------------------------------------