Provider Demographics
NPI:1568537082
Name:SCHULTA, MARLA J (APNP APN)
Entity Type:Individual
Prefix:MRS
First Name:MARLA
Middle Name:J
Last Name:SCHULTA
Suffix:
Gender:F
Credentials:APNP APN
Other - Prefix:MRS
Other - First Name:MARLA
Other - Middle Name:J
Other - Last Name:FREUDEN
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:APNP APN
Mailing Address - Street 1:4701 W SUMAC PL
Mailing Address - Street 2:
Mailing Address - City:MILWAUKEE
Mailing Address - State:WI
Mailing Address - Zip Code:53219
Mailing Address - Country:US
Mailing Address - Phone:414-327-0915
Mailing Address - Fax:
Practice Address - Street 1:1555 S LAYTON BLVD
Practice Address - Street 2:
Practice Address - City:MILWAUKEE
Practice Address - State:WI
Practice Address - Zip Code:53215
Practice Address - Country:US
Practice Address - Phone:414-385-6600
Practice Address - Fax:414-385-6612
Is Sole Proprietor?:No
Enumeration Date:2006-11-21
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WI73860-030163W00000X
WI1361-033363LP2300X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Not Answered163W00000XNursing Service ProvidersRegistered Nurse
Not Answered363LP2300XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerPrimary Care
Provider Identifiers
StateIdentifier IDID TypeIssuer
P33332Medicare UPIN