Provider Demographics
NPI:1073248951
Name:SCHULZE, TRAVIS RANDAL (CRNA)
Entity Type:Individual
Prefix:
First Name:TRAVIS
Middle Name:RANDAL
Last Name:SCHULZE
Suffix:
Gender:M
Credentials:CRNA
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:22399 186TH AVE
Mailing Address - Street 2:
Mailing Address - City:MANCHESTER
Mailing Address - State:IA
Mailing Address - Zip Code:52057-8682
Mailing Address - Country:US
Mailing Address - Phone:318-272-9888
Mailing Address - Fax:
Practice Address - Street 1:712 W MAIN ST
Practice Address - Street 2:
Practice Address - City:MANCHESTER
Practice Address - State:IA
Practice Address - Zip Code:52057-1525
Practice Address - Country:US
Practice Address - Phone:563-822-1435
Practice Address - Fax:563-822-1436
Is Sole Proprietor?:Yes
Enumeration Date:2022-07-23
Last Update Date:2023-07-25
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IAD175009367500000X
MO2019031860163W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes163W00000XNursing Service ProvidersRegistered NurseGroup - Single Specialty
No367500000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse Anesthetist, Certified RegisteredGroup - Single Specialty