Provider Demographics
NPI:1295036457
Name:SCHULTZ, KATELYN JEAN (PA-C)
Entity Type:Individual
Prefix:MS
First Name:KATELYN
Middle Name:JEAN
Last Name:SCHULTZ
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Gender:F
Credentials:PA-C
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Mailing Address - Street 1:2247 WEST WABANSIA AVENUE
Mailing Address - Street 2:204
Mailing Address - City:CHICAGO
Mailing Address - State:IL
Mailing Address - Zip Code:60647
Mailing Address - Country:US
Mailing Address - Phone:651-442-1713
Mailing Address - Fax:312-926-3231
Practice Address - Street 1:1460 N HALSTED ST
Practice Address - Street 2:SUITE 504
Practice Address - City:CHICAGO
Practice Address - State:IL
Practice Address - Zip Code:60642-2605
Practice Address - Country:US
Practice Address - Phone:312-926-3627
Practice Address - Fax:312-926-3231
Is Sole Proprietor?:Yes
Enumeration Date:2010-11-04
Last Update Date:2012-09-13
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Provider Licenses
StateLicense IDTaxonomies
IL085003904363A00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363A00000XPhysician Assistants & Advanced Practice Nursing ProvidersPhysician Assistant