MEDICARE: MS. THERESA SCHUETZE RN

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	163W00000X	Registered Nurse	205791	MA
2	163W00000X	Registered Nurse	026-0034572	VT

Other Identifiers

#	Provider Identifier	Provider Identifier Type	Provider Identifier State	Provider Identifier Issuer
1	205791	OTHER	MA	RN LICENSE
2	0709999	OTHER	MA	MASSHEALTH NUMBER
3	026-0034572	OTHER	VT	RN LICENSE NUMBER

General Provider Information

NPI Number	:	1912029885
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	MS. THERESA SCHUETZE RN

Provider Business Mailing Address
First Line	:	17 SOUTH STREET
Second Line	:
City	:	BUCKLAND
State	:	MA
Zip	:	01370
Country	:	US
Telephone Number	:	413-625-2349
Fax Number	:

Provider Business Practice Location Address
First Line	:	17 SOUTH ST
Second Line	:
City	:	SHELBURNE FALLS
State	:	MA
Zip	:	01370-9573
Country	:	US
Telephone Number	:	413-625-2349
Fax Number	:

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

Provider Enumeration Date	:	04/04/2007
Last Update Date	:	07/08/2007

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