Provider Demographics
NPI:1235851254
Name:SHULTZ, MANDI BETH (RN)
Entity Type:Individual
Prefix:
First Name:MANDI
Middle Name:BETH
Last Name:SHULTZ
Suffix:
Gender:F
Credentials:RN
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1706 W 30TH AVE
Mailing Address - Street 2:
Mailing Address - City:KENNEWICK
Mailing Address - State:WA
Mailing Address - Zip Code:99337-2887
Mailing Address - Country:US
Mailing Address - Phone:509-302-5313
Mailing Address - Fax:509-582-0789
Practice Address - Street 1:123 S KENT ST
Practice Address - Street 2:
Practice Address - City:KENNEWICK
Practice Address - State:WA
Practice Address - Zip Code:99336-5020
Practice Address - Country:US
Practice Address - Phone:509-222-5103
Practice Address - Fax:509-222-5101
Is Sole Proprietor?:No
Enumeration Date:2022-09-15
Last Update Date:2022-09-15
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WARN00144317163WS0200X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes163WS0200XNursing Service ProvidersRegistered NurseSchool