Provider Demographics
NPI:1497532436
Name:SCHULTZ, MALLORY NICOLE (AGACNP-BC)
Entity Type:Individual
Prefix:MS
First Name:MALLORY
Middle Name:NICOLE
Last Name:SCHULTZ
Suffix:
Gender:F
Credentials:AGACNP-BC
Other - Prefix:
Other - First Name:MALLORY
Other - Middle Name:
Other - Last Name:REED
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:
Mailing Address - Street 1:3025 BLOSSOM CIR
Mailing Address - Street 2:
Mailing Address - City:SAGINAW
Mailing Address - State:MI
Mailing Address - Zip Code:48603-5208
Mailing Address - Country:US
Mailing Address - Phone:989-701-0276
Mailing Address - Fax:
Practice Address - Street 1:1170 MICHIGAN RD
Practice Address - Street 2:
Practice Address - City:PORT HURON
Practice Address - State:MI
Practice Address - Zip Code:48060-4658
Practice Address - Country:US
Practice Address - Phone:810-987-1700
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2023-09-13
Last Update Date:2023-09-13
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MI4704313474363L00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363L00000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse Practitioner