Provider Demographics
NPI:1003123365
Name:SCHULTZ, MAVIS A (ARNP)
Entity Type:Individual
Prefix:
First Name:MAVIS
Middle Name:A
Last Name:SCHULTZ
Suffix:
Gender:F
Credentials:ARNP
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:3100 N HILLSIDE ST
Mailing Address - Street 2:
Mailing Address - City:WICHITA
Mailing Address - State:KS
Mailing Address - Zip Code:67219-3904
Mailing Address - Country:US
Mailing Address - Phone:316-682-3100
Mailing Address - Fax:316-618-8537
Practice Address - Street 1:3100 N HILLSIDE ST
Practice Address - Street 2:
Practice Address - City:WICHITA
Practice Address - State:KS
Practice Address - Zip Code:67219-3904
Practice Address - Country:US
Practice Address - Phone:316-682-3100
Practice Address - Fax:316-618-8537
Is Sole Proprietor?:No
Enumeration Date:2010-09-08
Last Update Date:2010-09-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
KS44028363L00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363L00000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse Practitioner
Provider Identifiers
StateIdentifier IDID TypeIssuer
KSB68645OtherOPERATED UNDER MD UPIN NUMBER
KS015757OtherOPERATED UNDER MD MEDICARE PIN/UPIN NUMBER