Provider Demographics
NPI:1629138466
Name:SCHULTZ, JOHN R (LPN)
Entity Type:Individual
Prefix:MR
First Name:JOHN
Middle Name:R
Last Name:SCHULTZ
Suffix:
Gender:M
Credentials:LPN
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:11460 REHM RD
Mailing Address - Street 2:
Mailing Address - City:CAMDEN
Mailing Address - State:NY
Mailing Address - Zip Code:13316-5423
Mailing Address - Country:US
Mailing Address - Phone:315-245-4383
Mailing Address - Fax:315-245-5631
Practice Address - Street 1:11460 REHM RD
Practice Address - Street 2:
Practice Address - City:CAMDEN
Practice Address - State:NY
Practice Address - Zip Code:13316-5423
Practice Address - Country:US
Practice Address - Phone:315-245-4383
Practice Address - Fax:315-245-5631
Is Sole Proprietor?:Yes
Enumeration Date:2006-12-11
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY234623164W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes164W00000XNursing Service ProvidersLicensed Practical Nurse