Provider Demographics
NPI:1235438433
Name:SCHULTZ, MARK G (NURSE PRACTITIONER)
Entity Type:Individual
Prefix:MR
First Name:MARK
Middle Name:G
Last Name:SCHULTZ
Suffix:
Gender:M
Credentials:NURSE PRACTITIONER
Other - Prefix:
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Mailing Address - Street 1:15-2817 PAPAI ST
Mailing Address - Street 2:
Mailing Address - City:PAHOA
Mailing Address - State:HI
Mailing Address - Zip Code:96778-8548
Mailing Address - Country:US
Mailing Address - Phone:808-769-2373
Mailing Address - Fax:808-930-4721
Practice Address - Street 1:16-590 OLD VOLCANO RD STE B
Practice Address - Street 2:
Practice Address - City:KEAAU
Practice Address - State:HI
Practice Address - Zip Code:96749-8158
Practice Address - Country:US
Practice Address - Phone:808-333-3450
Practice Address - Fax:808-930-4721
Is Sole Proprietor?:Yes
Enumeration Date:2011-03-28
Last Update Date:2023-12-18
Deactivation Date:
Deactivation Code:
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Provider Licenses
StateLicense IDTaxonomies
AK1157363LF0000X
WA60133272363LF0000X
HIAPRN-3257363LF0000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LF0000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerFamily