Provider Demographics
NPI:1336463645
Name:SCHULTZ-GONTARZ, VICKI ANNE (RN, MS, CPON, APN)
Entity Type:Individual
Prefix:MRS
First Name:VICKI
Middle Name:ANNE
Last Name:SCHULTZ-GONTARZ
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Gender:F
Credentials:RN, MS, CPON, APN
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Mailing Address - Street 1:5841 S MARYLAND AVE
Mailing Address - Street 2:MC 4060
Mailing Address - City:CHICAGO
Mailing Address - State:IL
Mailing Address - Zip Code:60637-1447
Mailing Address - Country:US
Mailing Address - Phone:773-834-8115
Mailing Address - Fax:773-702-9881
Practice Address - Street 1:5841 S MARYLAND AVE
Practice Address - Street 2:MC 4060
Practice Address - City:CHICAGO
Practice Address - State:IL
Practice Address - Zip Code:60637-1447
Practice Address - Country:US
Practice Address - Phone:773-834-8115
Practice Address - Fax:773-702-9881
Is Sole Proprietor?:Yes
Enumeration Date:2010-03-16
Last Update Date:2010-03-16
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Provider Licenses
StateLicense IDTaxonomies
IL209002789163WP0218X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes163WP0218XNursing Service ProvidersRegistered NursePediatric Oncology