Provider Demographics
NPI:1093293433
Name:SCHULTZ, AMBER RENEE
Entity Type:Individual
Prefix:
First Name:AMBER
Middle Name:RENEE
Last Name:SCHULTZ
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:109 WILLOW ST
Mailing Address - Street 2:
Mailing Address - City:SPARLAND
Mailing Address - State:IL
Mailing Address - Zip Code:61565-9481
Mailing Address - Country:US
Mailing Address - Phone:309-469-0005
Mailing Address - Fax:
Practice Address - Street 1:109 WILLOW ST
Practice Address - Street 2:
Practice Address - City:SPARLAND
Practice Address - State:IL
Practice Address - Zip Code:61565-9481
Practice Address - Country:US
Practice Address - Phone:309-469-0005
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2018-07-28
Last Update Date:2018-07-28
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IL043.108648164W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes164W00000XNursing Service ProvidersLicensed Practical Nurse