Provider Demographics
NPI:1194816595
Name:SCHULTZ, LISA (FNP)
Entity Type:Individual
Prefix:
First Name:LISA
Middle Name:
Last Name:SCHULTZ
Suffix:
Gender:F
Credentials:FNP
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:PO BOX 23340
Mailing Address - Street 2:
Mailing Address - City:SAINT LOUIS
Mailing Address - State:MO
Mailing Address - Zip Code:63156-3340
Mailing Address - Country:US
Mailing Address - Phone:314-647-9444
Mailing Address - Fax:314-647-7317
Practice Address - Street 1:1031 BELLEVUE
Practice Address - Street 2:STE 280
Practice Address - City:ST. LOUIS
Practice Address - State:MO
Practice Address - Zip Code:63114
Practice Address - Country:US
Practice Address - Phone:314-647-9444
Practice Address - Fax:314-647-7317
Is Sole Proprietor?:No
Enumeration Date:2006-09-28
Last Update Date:2011-05-12
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MO141894363LF0000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LF0000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerFamily