Provider Demographics
NPI:1558115717
Name:SCHULZ, MYRANDA LYNNE
Entity Type:Individual
Prefix:PROF
First Name:MYRANDA
Middle Name:LYNNE
Last Name:SCHULZ
Suffix:
Gender:F
Credentials:
Other - Prefix:MISS
Other - First Name:MYRANDA
Other - Middle Name:LYNNE
Other - Last Name:PRATHER
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:
Mailing Address - Street 1:12699 BLUEBELL AVE NE
Mailing Address - Street 2:
Mailing Address - City:HARTVILLE
Mailing Address - State:OH
Mailing Address - Zip Code:44632-9642
Mailing Address - Country:US
Mailing Address - Phone:330-815-0568
Mailing Address - Fax:
Practice Address - Street 1:12699 BLUEBELL AVE NE
Practice Address - Street 2:
Practice Address - City:HARTVILLE
Practice Address - State:OH
Practice Address - Zip Code:44632-9642
Practice Address - Country:US
Practice Address - Phone:330-815-0568
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2024-04-15
Last Update Date:2024-04-15
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes253Z00000XAgenciesIn Home Supportive Care