Provider Demographics
NPI:1083167100
Name:CARPENTER-SCHULTZ, TALONA SUE (NP)
Entity Type:Individual
Prefix:
First Name:TALONA
Middle Name:SUE
Last Name:CARPENTER-SCHULTZ
Suffix:
Gender:F
Credentials:NP
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:8932 9 1/2 MILE RD
Mailing Address - Street 2:
Mailing Address - City:CERESCO
Mailing Address - State:MI
Mailing Address - Zip Code:49033-9697
Mailing Address - Country:US
Mailing Address - Phone:269-209-3843
Mailing Address - Fax:
Practice Address - Street 1:322 MCINTYRE LN
Practice Address - Street 2:
Practice Address - City:SPRINGFIELD
Practice Address - State:MI
Practice Address - Zip Code:49037-7685
Practice Address - Country:US
Practice Address - Phone:269-209-3843
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2016-07-25
Last Update Date:2017-01-12
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MI4704217211363LP2300X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LP2300XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerPrimary Care