Provider Demographics
NPI:1235404849
Name:SCHULTZ, DEBORAH WYNN (NP)
Entity Type:Individual
Prefix:
First Name:DEBORAH
Middle Name:WYNN
Last Name: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 1:1430 SAN JULIAN ST
Mailing Address - Street 2:NURSING SERVICES BLDG. 2
Mailing Address - City:LOS ANGELES
Mailing Address - State:CA
Mailing Address - Zip Code:90015-3142
Mailing Address - Country:US
Mailing Address - Phone:213-765-2800
Mailing Address - Fax:
Practice Address - Street 1:1430 SAN JULIAN ST
Practice Address - Street 2:NURSING SERVICES BLDG. 2
Practice Address - City:LOS ANGELES
Practice Address - State:CA
Practice Address - Zip Code:90015-3142
Practice Address - Country:US
Practice Address - Phone:213-765-2800
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2012-03-14
Last Update Date:2012-03-20
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA225347163WS0200X, 363LS0200X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LS0200XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerSchool
No163WS0200XNursing Service ProvidersRegistered NurseSchool