Provider Demographics
NPI:1114194206
Name:SCHULTZ, MARY ROCHELLE (RN-CPNP)
Entity Type:Individual
Prefix:
First Name:MARY
Middle Name:ROCHELLE
Last Name:SCHULTZ
Suffix:
Gender:F
Credentials:RN-CPNP
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:18057 HIGHWAY 105 W STE 220
Mailing Address - Street 2:
Mailing Address - City:MONTGOMERY
Mailing Address - State:TX
Mailing Address - Zip Code:77356-5985
Mailing Address - Country:US
Mailing Address - Phone:936-582-5620
Mailing Address - Fax:936-582-5621
Practice Address - Street 1:18057 HIGHWAY 105 W STE 220
Practice Address - Street 2:
Practice Address - City:MONTGOMERY
Practice Address - State:TX
Practice Address - Zip Code:77356-5985
Practice Address - Country:US
Practice Address - Phone:936-582-5620
Practice Address - Fax:936-582-5621
Is Sole Proprietor?:No
Enumeration Date:2008-05-08
Last Update Date:2008-05-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TX545024363LP0200X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LP0200XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerPediatrics