=====================================================
General NPI Number Information
=====================================================
NPI Number | 1619014362
-----------------------------------------------------
Entity Type | Individual
-----------------------------------------------------
Provider Name | SHARON ELIZABETH SCHULTZ MS, NP-C
-----------------------------------------------------
Gender | Female
-----------------------------------------------------
=====================================================
Dates
=====================================================
Enumeration Date | 01/31/2007
-----------------------------------------------------
Last Update Date | 07/22/2019
-----------------------------------------------------
=====================================================
Provider Practice Location Address
=====================================================
Address Line | 4027 COUNTY ROAD 25
-----------------------------------------------------
City | ST LOUIS PARK
-----------------------------------------------------
State | MN
-----------------------------------------------------
Zip | 55416
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 612-925-6033
-----------------------------------------------------
Fax | 612-925-8496
-----------------------------------------------------
=====================================================
Provider Business Mailing Address
=====================================================
Address Line | 4240 PARK GLEN RD
-----------------------------------------------------
City | ST LOUIS PARK
-----------------------------------------------------
State | MN
-----------------------------------------------------
Zip | 55416-5427
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 612-925-6033
-----------------------------------------------------
Fax | 612-925-8496
-----------------------------------------------------
=====================================================
Authorized Official
=====================================================
Title or Position |
-----------------------------------------------------
Name |
-----------------------------------------------------
Credential |
-----------------------------------------------------
Telephone |
-----------------------------------------------------
=====================================================
Scope of Practice (Provider's specialty)
=====================================================
Taxonomy #1
-----------------------------------------------------
Taxonomy Code | 363LF0000X
-----------------------------------------------------
Taxonomy Name | Family Nurse Practitioner
-----------------------------------------------------
License Number | 602035
-----------------------------------------------------
License Number State | TX
-----------------------------------------------------
Taxonomy #2
-----------------------------------------------------
Taxonomy Code | 363L00000X
-----------------------------------------------------
Taxonomy Name | Nurse Practitioner
-----------------------------------------------------
License Number | CNP4374
-----------------------------------------------------
License Number State | MN
-----------------------------------------------------