MEDICARE: MS. MALLORY NICOLE SCHULTZ AGACNP-BC

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	363L00000X	Nurse Practitioner	4704313474	MI

General Provider Information

NPI Number	:	1497532436
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	MS. MALLORY NICOLE SCHULTZ AGACNP-BC

Provider Business Mailing Address
First Line	:	3025 BLOSSOM CIR
Second Line	:
City	:	SAGINAW
State	:	MI
Zip	:	48603-5208
Country	:	US
Telephone Number	:	989-701-0276
Fax Number	:

Provider Business Practice Location Address
First Line	:	1170 MICHIGAN RD
Second Line	:
City	:	PORT HURON
State	:	MI
Zip	:	48060-4658
Country	:	US
Telephone Number	:	810-987-1700
Fax Number	:

Authorized Official
Title or Position	:
Name	:
Credential	:
Telephone Number	:

Provider Enumeration Date	:	09/13/2023
Last Update Date	:	09/13/2023

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