Provider Demographics
NPI:1508450446
Name:SCHULZE, THERESA A (NURSE PRACTITIONER)
Entity Type:Individual
Prefix:
First Name:THERESA
Middle Name:A
Last Name:SCHULZE
Suffix:
Gender:F
Credentials:NURSE PRACTITIONER
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:63 GRAND AVE
Mailing Address - Street 2:
Mailing Address - City:RIVER EDGE
Mailing Address - State:NJ
Mailing Address - Zip Code:07661-1930
Mailing Address - Country:US
Mailing Address - Phone:201-487-2900
Mailing Address - Fax:201-487-1022
Practice Address - Street 1:63 GRAND AVE
Practice Address - Street 2:
Practice Address - City:RIVER EDGE
Practice Address - State:NJ
Practice Address - Zip Code:07661-1930
Practice Address - Country:US
Practice Address - Phone:201-487-2900
Practice Address - Fax:201-487-1022
Is Sole Proprietor?:Yes
Enumeration Date:2021-02-22
Last Update Date:2021-02-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NJ26NJ01105500363L00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363L00000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse Practitioner