Provider Demographics
NPI:1326634080
Name:BRYAN-SCHATZ, NANCY
Entity Type:Individual
Prefix:
First Name:NANCY
Middle Name:
Last Name:BRYAN-SCHATZ
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:8360 HIGHWAY CC
Mailing Address - Street 2:
Mailing Address - City:LESLIE
Mailing Address - State:MO
Mailing Address - Zip Code:63056-2033
Mailing Address - Country:US
Mailing Address - Phone:573-200-4052
Mailing Address - Fax:
Practice Address - Street 1:1326 S SERVICE RD W STE 10
Practice Address - Street 2:
Practice Address - City:SULLIVAN
Practice Address - State:MO
Practice Address - Zip Code:63080-2306
Practice Address - Country:US
Practice Address - Phone:573-468-4455
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2020-12-17
Last Update Date:2020-12-17
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MO2020041676363LF0000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LF0000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerFamily