Provider Demographics
NPI:1568517142
Name:JOHANNSSEN-SCHULTZ, INGEBORG (APRN)
Entity Type:Individual
Prefix:MS
First Name:INGEBORG
Middle Name:
Last Name:JOHANNSSEN-SCHULTZ
Suffix:
Gender:F
Credentials:APRN
Other - Prefix:MS
Other - First Name:INGE
Other - Middle Name:
Other - Last Name:JOHANNSSEN-SCHULTZ
Other - Suffix:
Other - Last Name Type:Professional Name
Other - Credentials:APRN
Mailing Address - Street 1:34 OLD FARM RD
Mailing Address - Street 2:
Mailing Address - City:NEW FAIRFIELD
Mailing Address - State:CT
Mailing Address - Zip Code:06812-2623
Mailing Address - Country:US
Mailing Address - Phone:
Mailing Address - Fax:
Practice Address - Street 1:41 KENOSIA AVE
Practice Address - Street 2:SUITE 201
Practice Address - City:DANBURY
Practice Address - State:CT
Practice Address - Zip Code:06810-7360
Practice Address - Country:US
Practice Address - Phone:203-744-2243
Practice Address - Fax:203-798-1513
Is Sole Proprietor?:Yes
Enumeration Date:2007-01-24
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CT001502363LP0808X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LP0808XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerPsychiatric/Mental Health