Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 363L00000X | Nurse Practitioner | 44028 | KS |
NPI | 1003123365 |
---|---|
Provider Name | Mavis A Schultz |
First Address | Wichita, KS 67219-3904 |
Second Address | Wichita, KS 67219-3904 |
Gender | F |
NPI Entity type | Individual |
Is Sole Proprietor | No |
Is Organization Subpart | N/A |
Enumeration Date | 08/09/2010 |
Last Update Date | 08/09/2010 |
IDENTIFIER | TYPE / CODE | IDENTIFIER STATE |
---|---|---|
015757 | OPERATED UNDER MD MEDICARE PIN/UPIN NUMBER (01) | KS |
B68645 | OPERATED UNDER MD UPIN NUMBER (01) | KS |