Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 207RR0500X | Rheumatology | 22384 | OK |
NPI | 1063462430 |
---|---|
Provider Name | Amy Lynn Shultz |
First Address | Duncan, OK 73533-1315 |
Second Address | Duncan, OK 73533-1315 |
Gender | F |
NPI Entity type | Individual |
Is Sole Proprietor | Yes |
Is Organization Subpart | N/A |
Enumeration Date | 10/05/2006 |
Last Update Date | 29/09/2016 |
IDENTIFIER | TYPE / CODE | IDENTIFIER STATE |
---|---|---|
200069950A | (05) | OK |
H95862 | (02) | OK |